title: Extrahepatic Glissonean approach for laparoscopic major liver resection (with video).
abstract: Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic major liver resection remains a highly specialized field because there are major technical difficulties, such as hilar dissection and pedicle control. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver. In contrast, the trunks of the secondary branches and more peripheral branches run inside the liver. The right, left, anterior, or posterior Glissonean pedicle can thus be tied and divided en bloc extrahepatically during open anatomical liver resection. Each Glissonean pedicle can be easily and safely encircled and divided en bloc extrahepatically during laparoscopic anatomical liver resection using an Endo Retract Maxi or Endo Mini-Retract. This report describes a novel technique by which the extrahepatic Glissonean approach appears to be both feasible and safe for the performance of laparoscopic major liver resection.
authors.affiliation: Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chuou-ku, Chiba 260-8717, Japan. acho@chiba-cc.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Cho
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Kainuma
authors.forename: Takumi
authors.initials: T
authors.lastname: Ota
authors.forename: SeongJin
authors.initials: S
authors.lastname: Park
authors.forename: Hidehito
authors.initials: H
authors.lastname: Arimitsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ikeda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Souda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takiguchi
authors.forename: Matsuo
authors.initials: M
authors.lastname: Nagata
mesh_terms: D004867:Equipment Design; D005240:Feasibility Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000295:instrumentation; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery*; D014111:Tourniquets