Laparoscopic anatomical S3 segmentectomy by the glissonian approach

Area of Science:

• Hepatobiliary surgery
• Minimally invasive liver resection
• Surgical oncology

Background:

• Severe cirrhosis necessitates strategies to preserve hepatic volume.
• Isolated resection of segment 3 (Sg3) is a potential approach.
• Laparoscopic anatomical Sg3 segmentectomy offers a minimally invasive option.

Purpose of the Study:

• To describe a laparoscopic anatomical Sg3 segmentectomy using an extrahepatic Glissonian approach.
• To evaluate the feasibility and safety of this technique for hepatocellular carcinoma.
• To highlight its utility in preserving hepatic volume.

Main Methods:

• Dissection of falciform and coronary ligaments.
• Isolation of the Glissonian pedicle to Sg3 using laparoscopic CUSA and suction.
• Temporary occlusion, margin confirmation, and transection of Sg3 followed by control of vascular structures and ligation of the main Sg3 Glissonian pedicle.

Main Results:

• Procedure completed in 175 minutes with 30 mL blood loss.
• Patient discharged on postoperative day 3 with no complications.
• Pathology confirmed hepatocellular carcinoma (pT2) with a 0.3 cm tumor-free margin.

Conclusions:

• Laparoscopic anatomical Sg3 segmentectomy is feasible and safe for treating hepatocellular carcinoma.
• This technique aids in preserving hepatic parenchymal volume.
• It represents a valuable option when hepatic volume preservation is critical.