Glissonian approach for laparoscopic mesohepatectomy.

Area of Science:

• Minimally invasive surgery
• Hepatobiliary surgery
• Surgical oncology

Background:

• Laparoscopic liver resection is increasingly indicated with advanced techniques.
• This video demonstrates a pure laparoscopic mesohepatectomy using an intrahepatic Glissonian approach.
• This is the first reported case of anatomic laparoscopic mesohepatectomy using the Glissonian approach in English literature.

Observation:

• A 62-year-old male with colorectal liver metastasis underwent laparoscopic mesohepatectomy.
• The procedure involved precise control of segment 4 and the right anterior pedicle using the Glissonian sheath.
• Liver transection was performed using advanced laparoscopic devices.

Findings:

• The surgery was completed in 200 minutes with minimal blood loss and no transfusion required.
• The patient experienced an uneventful recovery and was discharged on postoperative day 5.
• Histological examination confirmed clear surgical margins.

Implications:

• Laparoscopic mesohepatectomy is feasible and safe in select patients by experienced surgeons.
• The intrahepatic Glissonian approach aids in defining resection margins, preventing remnant liver injury.
• This technique advances minimally invasive options for complex liver resections.