LAPAROSCOPIC ANATOMIC LIVER RESECTION OF SEGMENT 7 AND 8 USING INTRAHEPATIC GLISSONEAN APPROACH

Segmentectomy is an anatomic liver resection, in which the tertiary branches of the Glissonean pedicles are selectively transected. However, the branching pattern of the tertiary branches varies depending on the case, particularly in segment 7 (S7) and segment 8 (S8). The extrahepatic approach to the Glissonean pedicle from the hepatic hilum is very difficult depending on the branching pattern. Furthermore, the distance of exposing the secondary branches that are to be preserved becomes longer, and there is an increased risk of biliary leakage and delayed biliary stricture due to excessive traction in laparoscopic surgery. Therefore, laparoscopic S7 and S8 segmentectomy are considered technically difficult. We standardized the intrahepatic Glissonean Pedicle Approach for laparoscopic S7 and S8 segmentectomy. We identify the targeted Glissonean pedicle intrahepatically after the parenchymal transection along the major hepatic vein or its branch running on the intersegmental plane, referring to the preoperative simulation by 3D imaging. About S7 segmentectomy, after the mobilization of the right lobe, the Glissonean pedicles of S7 (G7) can be approached from the dorsal side by transecting the parenchyma between the IVC and the right hepatic vein. After the division of the G7, the parenchyma is transected along the demarcation line and the RHV from the root side to the peripheral side. About S8 segmentectomy, first, the parenchyma is transected along the middle hepatic vein (MHV) from the root side to the peripheral. G8 is typically detected on the right dorsal side of the MHV. After the division of the G8, the liver parenchyma is transected along the demarcation line and the RHV from the root side to the peripheral side. Our approach to the G7 and the G8 is safe and very useful.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019