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Updated: May 23, 2026
Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein
Published on: September 27, 2024
A novel extra-glissonian approach for totally laparoscopic left hepatectomy
Fernando Rotellar1, Fernando Pardo, Alberto Benito
1Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, Avda.Pio XII n°36 Pamplona, Spain. frotellar@unav.es
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.
