Full Laparoscopic Anatomical Segment 8 Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence

Berardi, Giammauro; Wakabayashi, Go; Igarashi, Kento; Ozaki, Takehiro; Toyota, Naoyuki; Tsuchiya, Akihiko; Nishikawa, Kou

doi:10.1245/s10434-019-07422-8

Cited by 50 publications

(56 citation statements)

References 12 publications

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“…This is interesting because segmentectomy can be technically more demanding than major hepatectomy, where extraparenchymal control of the hepatic inflow and outflow is easier compared with the intraparenchymal or glissonean approach to control the segmental blood supply. 23,24 The blood loss was significantly lower in the LS group. This data was confirmed in the posterosuperior segments but not in the anterolateral segments.…”

Section: Discussionmentioning

confidence: 89%

Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

Garbarino¹,

Marchese²,

Tobome

et al. 2020

HPB

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Section: Discussionmentioning

confidence: 89%

Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

Garbarino¹,

Marchese²,

Tobome

et al. 2020

HPB

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“…Many reports have been recently published with an aim to standardize LALR procedures based on the concept of Laennec's capsule [10,16,17,[21][22][23]. In addition to these previous surgical techniques, our left medial sectionectomy approach also has potential for use in other LALRs and as a safe and curative method to prevent intraoperative complications, such as unexpected massive bleeding.…”

Section: Discussionmentioning

confidence: 99%

How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec’s capsule

Hanzawa

Monden

Hioki

et al. 2021

Langenbecks Arch Surg

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Background Laparoscopic anatomic liver resection is technically demanding, given the need to safely isolate the Glissonean pedicles and expose the hepatic veins (HVs) on the liver parenchyma cut surface. Laennec’s capsule is observed around the Glissonean pedicles and root of the HVs. However, its existence, particularly on the peripheral side of the HVs, remains controversial. Herein, we describe Laennec’s capsule-related histopathological findings around the HVs and a safe laparoscopic left medial sectionectomy utilizing Laennec’s capsule. Methods The extrahepatic Glissonean approach was performed by connecting Gates II and III, in accordance with Sugioka’s Gate theory. Liver parenchymal transection commenced along the demarcation line, which is between the medial and lateral sections, and the G4 was dissected during transection. Subsequently, via the outer-Laennec approach, the middle hepatic vein (MHV) was exposed from the root side in cranial view, while Laennec’s capsule was preserved. Parenchymal transection was completed while connecting the MHV with the demarcation line. We obtained the membrane surrounding the HVs and performed histopathological examinations. Results Six patients underwent laparoscopic left medial sectionectomy from February 2012 to November 2020. There were no cases involving complications (Clavien–Dindo classification; grade II or higher), open-surgery conversion, transfusion, or surgery-related death. The histopathological findings showed Laennec’s capsule surrounding both the trunk of the major HVs and the peripheral side of the HVs. Conclusions A cranial approach to the major HVs utilizing Laennec’s capsule is a feasible and advantageous procedure for laparoscopic left medial sectionectomy. We propose that Laennec’s capsule surrounds the entire length of the HVs.

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“…Thus, puncturing the corresponding portal veins one by one is di cult, and the borders of the S8 area with dye staining may not display accurately. The above factors lead to a low puncture success rate, and therefore, this approach has been di cult to popularize in a short time [3]. The Glisson pedicle approach refers to removal of S8 after isolation of S8 Glissonean pedicle branch from the right anterior and posterior pedicles.…”

Section: Discussionmentioning

confidence: 99%

“…There are many technical tips for LALR of S8, and the core technical tip is how to choose an appropriate laparoscopic approach, which is a main determinant of surgical success. To date, the approaches for LALR of S8 roughly include ultrasound-guided S8 segmental portal branch puncture, a hepatic hilum Glisson pedicle approach, and a left and right hemihepatic splitting approach [3][4][5]. However, all these approaches have certain drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Anatomical Resection of Liver Segment 8 via a Hepatic Parenchymal Transection-first Approach Guided by the Middle Hepatic Vein

You

et al. 2021

Preprint

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Background Although recent technological developments and improved endoscopic procedures have further extended the application of laparoscopic liver resection, pure laparoscopic anatomic resection of liver segment 8 (S8) is still rarely performed due to the lack of an appropriate surgical approach. This article discusses the technical tips and operation methods for laparoscopic anatomical resection of liver S8 via a hepatic parenchymal transection-first approach.Methods Clinical data of 14 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein (MHV) in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.Results The operation was successful with no complications. No other abnormality was noted during outpatient follow-up examination.Conclusions Laparoscopic anatomical resection of liver S8 is still quite challenging at present, and it is our goal to design a reasonable procedure with accurate efficacy and high safety. We use hepatic parenchymal transection-first approach guided by the MHV for laparoscopic anatomical resection of liver S8. This technique overcomes the problem of high technical risk, greatly reduces the surgical difficulty and achieves technological breakthroughs, but there are still many problems worth further exploration.

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Full Laparoscopic Anatomical Segment 8 Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence

Cited by 50 publications

References 12 publications

Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec’s capsule

Laparoscopic Anatomical Resection of Liver Segment 8 via a Hepatic Parenchymal Transection-first Approach Guided by the Middle Hepatic Vein

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