Laparoscopic anatomical segmentectomy using the transfissural Glissonean approach

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgery
• Surgical anatomy

Background:

• Anatomical segmentectomy is challenging due to complex liver anatomy.
• Conventional Glissonean approaches struggle with deep, variable tertiary portal pedicles.
• A novel transfissural Glissonean approach for laparoscopic liver segmentectomy is presented.

Purpose of the Study:

• To introduce and evaluate the transfissural Glissonean approach for purely laparoscopic anatomical liver segmentectomy.
• To demonstrate the technical feasibility and safety of this novel surgical technique.

Main Methods:

• Purely laparoscopic anatomical segmentectomy was performed using the transfissural Glissonean approach.
• The technique involves opening liver parenchyma along fissure lines to access pedicles.
• Tertiary portal pedicles were ligated within the liver parenchyma.

Main Results:

• 17 cases were performed between August 2014 and September 2019.
• Median operative time was 200 minutes, with median blood loss of 80 mL.
• Median hospital stay was 6 days, with no major morbidity or mortality.

Conclusions:

• The transfissural Glissonean approach is technically feasible for laparoscopic anatomical segmentectomy.
• Opening fissures provides direct access to tertiary portal pedicles, simplifying dissection.
• This method enhances safety and efficiency in complex liver resections.