[Two tapes to control the main fissure of the liver].
Herein we report a technique that allows a rapid and selective clamping of the left and right glissonian sheats and that secures the opening of the main fissure. The posterior face of segment IV capsula is opened immediately above the hilum on the left side of the gallbladder fossa. The tip of a right angled dissector is gently pushed in the liver substance from front to back while maintained against the hilar plate, until it arises in the caudate process just below the pedicle. A tape is used to encircle the Glisson sheath. Its inferior extremity can be picked up either on the right or the left side of the liver pedicle in order to clamp the right or the left portal pedicle, respectively. Both clamping precisely mark the anterior limit of the main fissure. Using a Kelly forceps, a second tape is introduced in the Couinaud space, between the inferior vena cava and segment one. The inferior extremity of this tape is then picked up above the Glisson sheat and allows to hang the posterior limit of the main fissure which can be securely approached. The two tapes technique cannot be applied when liver is fibrotic or when biliary ducts are dilated.
Boudjema
K
K
Département de chirurgie viscérale, unité de chirurgie hépatobiliaire et transplantation hépatique, hôpital Pontchaillou, 35033 Rennes, France. karim.boudjema@chu-rennes.fr
Veilhan
L A
LA
Dupont-Bierre
E
E
Lakehal
M
M
D013505:Digestive System Surgical Procedures / Q000379:methods*; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D013523:Surgical Equipment; D013525:Surgical Instruments; D014682:Vena Cava, Inferior / Q000601:surgery