title: A novel extra-glissonian approach for totally laparoscopic left hepatectomy.
abstract: BACKGROUND
  We describe a novel extra-glissonian approach (EGA) for totally laparoscopic left hepatectomy. Published techniques for totally laparoscopic left hepatectomy generally involve the selective ligation of the vascular and biliary elements of the left pedicle. The laparoscopic dissection of these structures can be tedious, difficult, and dangerous. The EGA has proven useful in open surgery for major hepatectomies. We feel that this approach could be even more useful in the laparoscopic context.
  
  
  METHODS
  We describe an extra-glissonian laparoscopic technique in which the left pedicle is isolated extraparenchymally, detaching the left hilar plate, with particular attention to preserving the branch for segment I. The left portal triad is encircled with a cotton tape and transected with an endostapler. This is performed totally extraparenchymally without damaging the surrounding parenchyma.
  
  
  RESULTS
  This EGA technique for laparoscopic left hepatectomy follows by laparoscopy the same steps and recommendations that make the EGA safe and effective in open surgery.
  
  
  CONCLUSIONS
  The EGA for LLH can be performed as described in open surgery, therefore offering the same advantages.
authors.affiliation: Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, Avda.Pio XII n°36 Pamplona, Spain. frotellar@unav.es
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo
authors.forename: Alberto
authors.initials: A
authors.lastname: Benito
authors.forename: Pablo
authors.initials: P
authors.lastname: Martí-Cruchaga
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zozaya
authors.forename: Nicolás
authors.initials: N
authors.lastname: Pedano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged