Surgical Glove Technique for Laparoscopic Liver Resection

Liver tumors located in segments 7 and 8 pose a technical challenge to standard laparoscopic liver resection. Intraoperative placement of a surgical glove behind the right liver after the right triangular ligament and coronary ligament are divided facilitates liver exposure during parenchymal transection and control of the bleeding at the deeper part of the parenchymal plane. The aim of this study was to describe our standardized technique in detail and to assess the feasibility of this technique in patients with different clinical backgrounds and clarify the limits of this technique.

Medical records of 20 consecutive patients considered for laparoscopic liver resection using the surgical glove technique were reviewed.

All patients had malignant disease and the vast majority of patients had colorectal metastatic tumors. Overall, 65% of patients had tumors located in segment 8. Placing the surgical water glove could be achieved without complication in all 20 patients. One surgical glove was used in this series (usually size 6.5 to 7.5 is an adequate size). Time for preparing the surgical green water glove was estimated to be less than 1 min. The mean duration of operation ranged from 136 to 332 min (median, 240 min). Intermittent Pringle's maneuver was applied in all patients with a median time of 33 min. No additional intercostal trocars were required. There was no intraoperative blood transfusion or conversion to open surgery. The median maximum size of the tumor was 23 mm. There was no operative mortality. Overall morbidity was 30%. Surgical margins were negative in 80% of patients.

The surgical glove technique is easy, reproducible, effective, and safe and can be applied to both laparoscopic and robotic liver resection.