Clinical Utility of Glissonean Guided Approach for Laparoscopic Extended Posterior Sectionectomy

Minimally invasive anatomical hepatectomy is performed worldwide.¹ During liver transection, the hepatic vein guided approach (HVGA) is often utilized.² However, when tumors invade major vessels, extended anatomical hepatectomy may be indicated, making the HVGA unsuitable. At our institution, the Glissonean-guided approach (GGA) has been adopted for laparoscopic extended posterior sectionectomy. This technique is conceptually similar to systematic extended right posterior sectionectomy, previously described in open surgery.³ This study presents the surgical procedure and perioperative outcomes of the GGA for this procedure.

In total, 19 patients underwent laparoscopic extended posterior sectionectomy. Among them, 11 patients were treated using the HVGA, while 8 were treated using the GGA. The perioperative outcomes were compared between the two groups.

No severe complications (Clavien-Dindo grade ≥ III) or in-hospital mortality occurred. Liver transection time was significantly shorter in the GGA group (p = 0.037), and blood loss was reduced (p = 0.033). The right hepatic vein (RHV) was divided in all cases. No significant differences were observed in IWATE criteria, postoperative hospital stay, or R0 resection rate, although the GGA group tended to have a higher R0 rate.

In laparoscopic extended posterior sectionectomy, the GGA demonstrated favorable perioperative outcomes, with a significantly reduced liver transection time in comparison with HVGA. The GGA also tended to be associated with higher R0 resection rates, although the difference was not statistically significant. The GGA may be a valuable alternative technique for cases in which the HVGA is not feasible owing to tumor location and vascular invasion.