title: Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach.
abstract: BACKGROUND
  Recent advances in laparoscopic techniques have resulted in growing indications for laparoscopic hepatectomy. However, this procedure has not been widely developed, and anatomic segmental liver resection is not currently performed due to difficulty controlling the segmental Glissonian pedicles laparoscopically. This study aimed to report a novel technique for laparoscopic anatomic resection of left liver segments using the intrahepatic Glissonian approach based on small incisions according to anatomic landmarks such as Arantius' and round ligaments.
  
  
  METHODS
  Nine consecutive patients underwent laparoscopic liver resection using the intrahepatic Glissonian technique from April 2007 to June 2008. Five patients underwent laparoscopic bisegmentectomy 2-3, one laparoscopic left hemihepatectomy, two resections of segment 3, and one resection of segment 4.
  
  
  RESULTS
  One patient required a blood transfusion. The mean operation time was 180 min (range, 120-300 min), and the median hospital stay was 3 days (range, 1-5 days). No patient had postoperative signs of liver failure or bile leakage. No postoperative mortality was observed.
  
  
  CONCLUSIONS
  The main advantage of the intrahepatic Glissonian procedure over other techniques is the possibility of gaining a rapid and precise access to the left Glissonian sheaths facilitating left hemihepatectomy, bisegmentectomy 2-3, and individual resections of segments 2, 3, and 4. The authors believe that the intrahepatic Glissonian technique facilitates laparoscopic liver resection and may increase the development of segment-based laparoscopic liver resection.
authors.affiliation: Department of Gastroenterology, University of São Paulo, Rua Evangelista Rodrigues, 407-05463-000, Sao Paulo, Brazil. dr@drmarcel.com.br
authors.forename: M A C
authors.initials: MA
authors.lastname: Machado
authors.forename: F F
authors.initials: FF
authors.lastname: Makdissi
authors.forename: R C
authors.initials: RC
authors.lastname: Surjan
authors.forename: P
authors.initials: P
authors.lastname: Herman
authors.forename: A R
authors.initials: AR
authors.lastname: Teixeira
authors.forename: M C
authors.initials: MC
authors.lastname: C Machado
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012494:Sampling Studies; D016896:Treatment Outcome