Laparoscopic Glissonean Approach for an atomic Central Hepatectomy

Long Tran Cong Duy, MD, Bac Nguyen Hoang, MD, PhD, Thuan Nguyen Duc, MD, Dat Le Tien, MD, Viet Dang Quoc, MD

HBP Surgery Division, UMC, Vietnam

Vietnam similar to other ASEAN countries, located in the epidermiologic area of HBV infection, as a result, HCC is rather common.

Hepatectomy is still the most popular curative treatment for HCC. Open hepatectomy usually leaded to much post-op pain and complications related to the large incision. Minimally invasive surgery may help patients with many benefits. However, laparoscopic surgery encountered several dificulties such as dissection of hepatic pendicles, inlet control, identifying the tumor (satelite) and surgical margin, hemostasis during dividing the parenchyma … and last but not least was the anatomic hepatectomy for better result in terms of the oncological view.

Hepatic pedicles dissection for identifying and controlling the Glissoneal pedicles of each segment has been proved effective and beneficial in open hepatectomy for HCC.

It’s our aim to evaluate the feasibility of laparoscopic surgery when applying this technique of hepatectomy. So that, we give more evidence for the potential of laparoscopic hepatectomy in HCC treatment.

Here, in this video, we present the the technique of laparoscopic Glissoneal pedicle dissection for anatomic central hepatectomy.
We use 5 ports. Patient position is suspine with 2 legs open. Surgeon stand in the right side of patient, the asssiatant on the left side and camera man between the patient legs.

The subumbilical 11mm port for the scope (45 degree scope).
The 12 mm port in the right flank as operating port.
One 5mm port in right subcostal for left hand retraction.
Another 5mm port in epigastric area for suction (assistant).
The last 5mm in left subcostal for liver retraction (assistant).
Firstly, the right liver is mobilised.
Cholecystectomy is performed.

Dissecting Hepatic hilus and exposing the Glissoneal pedicle of the posterior, anterior and the left sector.

Temporarily clamping the relevant pedicle of the anterior sector in order to identify the demarcation line on the liver surface. By this way, we determine the anatomic border of the sector as well as the surgical surface.

Anatomic hepatectomy along the border between the sector will encounter no large glissoneal pedicle, so we minimize the blood loss and better hemostasis during parechymal transection.

When applying this technique, the resecting sector is complete ischemia. The preserve sectors have good blood supply during the operation. The benefit of this is to avoid post-operative liver failure.

The Glissoneal pedicle of the involved sector is controlled at the beginning of the operation and the tumor together with the relevant portal vein (which may be seeding) is removed en bloc. This is more radical in terms of surgical oncology.
Patient well and quickly recovered because of benefits of minimally invasive surgery
Laparoscopic Glissoneal approach for anatomic liver resection is feasible and show the new trend for advanced laparoscopic liver resection.

Session: Video ChannelDay 3

Program Number: V106

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