606 INTRAHEPATIC GLISSONIAN APPROACH FOR REPEAT ROBOTIC LEFT HEPATECTOMY

The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.

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Robotic Left Hepatectomy for Mucinous Cystic Neoplasm: Tips for Intrahepatic Bleeding Control

The American Surgeon ◽

10.1177/0003134820956340 ◽

2020 ◽

pp. 000313482095634

Author(s):

Iswanto Sucandy ◽

Janelle Spence ◽

Sharona Ross ◽

Alexander Rosemurgy

Keyword(s):

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Bleeding Control ◽

Left Hepatectomy

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Intrahepatic Glissonian approach for robotic right hepatectomy

Surgical Oncology ◽

10.1016/j.suronc.2021.101579 ◽

2021 ◽

pp. 101579

Author(s):

Marcel Autran Machado ◽

Bruno H. Mattos ◽

Murillo Lobo Filho ◽

Fábio Makdissi

Keyword(s):

Right Hepatectomy ◽

Glissonian Approach

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Donor Morbidity Is Equivalent Between Right and Left Hepatectomy For Living Liver Donation: A meta‐analysis

Liver Transplantation ◽

10.1002/lt.26183 ◽

2021 ◽

Author(s):

Paola A. Vargas ◽

Emily KE McCracken ◽

Indika Mallawaarachchi ◽

Sarah J Ratcliffe ◽

Curtis Argo ◽

...

Keyword(s):

Meta Analysis ◽

Left Hepatectomy ◽

Liver Donation ◽

Living Liver Donation

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Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BMC Gastroenterology ◽

10.1186/s12876-021-01726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shaohe Wang ◽

Yang Yue ◽

Wenjie Zhang ◽

Qiaoyu Liu ◽

Beicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Caudate Lobe ◽

Postoperative Hospital Stay ◽

Dorsal Approach ◽

Glissonian Approach ◽

The Mean ◽

Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

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