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Laparoscopic glissonean approach: Making complex something easy or making suitable the unsuitable?

Marcel A Machado1, Fábio Makdissi2, Rodrigo Surjan1

  • 1Department of Surgery, University of São Paulo, Brazil.

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|July 17, 2019
PubMed
Summary

The laparoscopic glissonean approach offers a safe and effective method for liver surgery, demonstrating shorter operative times, reduced blood loss, and low morbidity. This technique is particularly advantageous for anatomical resections, requiring surgeon expertise and precise preoperative planning.

Keywords:
GlissoneanLaparoscopicLiver resection

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Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Surgery
  • Surgical Techniques

Background:

  • The laparoscopic glissonean approach presents potential benefits including reduced operative times, decreased blood loss, and lower morbidity in liver surgery.
  • This technique involves dissection of the glissonean pedicles, offering an alternative to traditional surgical methods.

Purpose of the Study:

  • To evaluate the technical aspects and outcomes of the laparoscopic glissonean approach in liver surgery over a 12-year period.
  • To assess the safety, feasibility, and clinical utility of this minimally invasive technique.

Main Methods:

  • A prospective database was utilized to analyze data from 327 patients who underwent laparoscopic glissonean liver resections.
  • Exclusion criteria included anatomical laparoscopic liver resections with hilar dissection and non-anatomical resections.

Main Results:

  • The study included 327 patients (mean age 56 years), with 60% undergoing major resections. Of these, 208 were for secondary lesions and 38 had cirrhotic livers.
  • Morbidity was 37.3%, with a 90-day mortality rate of 0.6% (2 patients). Blood transfusions were needed in 10.7% of patients, and the median hospital stay was 4 days.

Conclusions:

  • The laparoscopic glissonean approach is a safe and feasible technique for liver surgery, associated with shorter operative times, reduced blood loss, and low morbidity.
  • It is particularly superior to standard laparoscopic hepatectomy for anatomical resections, especially segment or section removals.
  • Successful application necessitates accurate preoperative tumor localization, identification of pedicle variations, and surgeon expertise.