title: Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients.
abstract: OBJECTIVE
  For treatment of centrally located hepatocellular carcinoma (HCC), mesohepatectomy is a technically demanding procedure. The technique of an intrahepatic access to Glissonian pedicles achieves a safe inflow blood control of the liver segments to be resected and allows the anatomical removal of the tumor-bearing segment(s). No reports have mentioned the use of an intrahepatic access for mesohepatectomy in cirrhotic livers.
  
  
  METHODS
  Seventeen consecutive patients underwent mesohepatectomy between January 1, 2005, and September 30, 2007. All these patients had hepatocellular carcinoma. The surgery was performed by making 3 small incisions around the hilar-plate, the gallbladder bed, and the round ligament. With a standardized method, the right anterior and left medial sheaths were reached by combining these incisions.
  
  
  RESULTS
  Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation, and 14 patients did not require blood transfusion. Minor postoperative complications were observed in 8 patients and resolved with conservative management. No hospital mortality occurred.
  
  
  CONCLUSIONS
  Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the Pringle maneuver.
authors.affiliation: Department of General Surgery, Second Affiliated Hospital, XiangYa Medical College Central South University, ChangSha, Hunan Province, PR China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Dai
authors.forename: Ji-Xiong
authors.initials: JX
authors.lastname: Hu
authors.forename: Xiong-Ying
authors.initials: XY
authors.lastname: Miao
authors.forename: De-Wu
authors.initials: DW
authors.lastname: Zhong
authors.forename: Yu
authors.initials: Y
authors.lastname: Wen
authors.forename: Shou-Zhi
authors.initials: SZ
authors.lastname: Xiong
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome