Tailored Strategy for Dissecting the Glissonean Pedicle in Laparoscopic Right Anterior Sectionectomy: The Extrahepatic, Intrahepatic, and Transfissural Glissonean Approaches (with Video)

Objective: To apply hepatectomy using Takasaki procedure to control Glissonean pedicle. Methods: A prospective, descriptive study on 31 patients undergoing hepatectomy using Takasaki Glissonean pedicle approach. Results: The mean age was 55 ± 11.7 (39 – 73 years), male/female ratio was 7.3. The mean operative time was 115 ± 37 minutes. The mean blood loss was 271 ± 119 ml. There was one case of common hepatic duct injury (3.6%). Postoperative complications occurred in 7(22.4%) patients. There was no postoperative mortality. Conclusions: Hepatectomy using Takasaki Glissonean pedicle approach was safe and effective technique. Keywords: Glissonean pedicle approach, hepatectomy

Download Full-text

Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

Case Reports in Gastroenterology ◽

10.1159/000468514 ◽

2017 ◽

Vol 11 (1) ◽

pp. 190-200

Author(s):

Satoshi Koizumi ◽

Kenta Katsumata ◽

Tatsunori Ono ◽

Kouhei Segami ◽

Hiroyuki Hoshino ◽

...

Keyword(s):

Surgical Treatment ◽

Damage Control ◽

Damage Control Surgery ◽

Liver Trauma ◽

Control Procedure ◽

Severe Liver ◽

Hepatic Hilus ◽

Initial Strategy ◽

Glissonean Pedicle ◽

Definitive Surgery

The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

Download Full-text

Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule

BMC Gastroenterology ◽

10.1186/s12876-019-1107-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Yue Hu ◽

Jiong Shi ◽

Shaohe Wang ◽

Wenjie Zhang ◽

Xitai Sun ◽

...

Keyword(s):

Surgical Technique ◽

Liver Diseases ◽

Vena Cava ◽

Operation Time ◽

Hepatic Veins ◽

The Novel ◽

Hanging Maneuver ◽

Glissonean Pedicle ◽

Hematoxylin And Eosin ◽

Hospital Days

Abstract Background Although isolating Glissonean pedicles and hepatic veins are critical procedures during anatomical hepatectomy, there is no standardized approach. We propose the novel Laennec’s approach for laparoscopic anatomic hepatectomy (LAH) based on Laennec’s capsule, which serves as the anatomic landmark for LAH. The aim of this study was to elucidate that the natural gap between Laennec’s capsule and the adjacent tissues contributes to standardization of the surgical technique for LAH. Methods Eighty-four cases were enrolled in this observable clinical trial. They underwent LAH for liver diseases. Laennec’s approach was proposed for LAH based on Laennec’s capsule. The liver tissues close to Glissonean pedicle, hepatic veins, naked area, and inferior vena cava were collected for hematoxylin and eosin, resorcinol-fuchsin staining, and immunohistochemistry. Results The staining revealed capsule packaging of the whole liver independent of the adjacent tissues and intrahepatic vessels. A natural gap was found between Laennec’s capsule and the adjacent tissues at different sites. Laennec’s capsule served as the landmark for isolating Glissonean pedicle and hepatic veins, mobilizing the liver, and performing Hanging maneuver. Eighty-four cases underwent LAH for liver diseases using this strategy. The operation time was 277.23 min. The mean of hospital days was 9.8. Conclusions Laennec’s approach based on Laennec’s capsule contributes to standardization of the surgical technique for LAH, and brings innovations that facilitates safe and effective liver resection under laparoscopy.

Download Full-text