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A novel extra-glissonian approach for totally laparoscopic left hepatectomy

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Abstract

Introduction

We describe a novel extra-glissonian approach (EGA) for totally laparoscopic left hepatectomy. Published techniques for totally laparoscopic left hepatectomy generally involve the selective ligation of the vascular and biliary elements of the left pedicle. The laparoscopic dissection of these structures can be tedious, difficult, and dangerous. The EGA has proven useful in open surgery for major hepatectomies. We feel that this approach could be even more useful in the laparoscopic context.

Methods

We describe an extra-glissonian laparoscopic technique in which the left pedicle is isolated extraparenchymally, detaching the left hilar plate, with particular attention to preserving the branch for segment I. The left portal triad is encircled with a cotton tape and transected with an endostapler. This is performed totally extraparenchymally without damaging the surrounding parenchyma.

Results

This EGA technique for laparoscopic left hepatectomy follows by laparoscopy the same steps and recommendations that make the EGA safe and effective in open surgery.

Conclusions

The EGA for LLH can be performed as described in open surgery, therefore offering the same advantages.

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Disclosures

Drs. Fernando Rotellar, Fernando Pardo, Alberto Benito, Pablo Martí-Cruchaga, and Gabriel Zozaya have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, Avda.Pio XII n°36, Pamplona, Spain

    Fernando Rotellar, Fernando Pardo, Pablo Martí-Cruchaga, Gabriel Zozaya & Nicolás Pedano

  2. Department of Radiology, University Clinic of Navarre, University of Navarre, Avda.Pio XII n°36, Pamplona, Spain

    Alberto Benito

Authors
  1. Fernando Rotellar
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  2. Fernando Pardo
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  3. Alberto Benito
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  4. Pablo Martí-Cruchaga
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  5. Gabriel Zozaya
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  6. Nicolás Pedano
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Corresponding author

Correspondence to Fernando Rotellar.

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Rotellar, F., Pardo, F., Benito, A. et al. A novel extra-glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc 26, 2617–2622 (2012). https://doi.org/10.1007/s00464-012-2242-3

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  • DOI: https://doi.org/10.1007/s00464-012-2242-3

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