title: Feasibility of the Glissonian approach during right hepatectomy.
abstract: OBJECTIVE
  The Glissonian approach during hepatectomy is a selective vascular clamping procedure associated with low rates of technical failure and complications. The aim of the present study was to assess the feasibility of a right Glissonian approach in relation to portal vein anatomy.
  
  
  METHODS
  This was a prospective study conducted over a 12-month period, which included 32 patients for whom preoperative three-dimensional reconstruction using contrast-enhanced computed tomography in the portal venous phase and portography for right portal vein embolization were available, and in whom a right Glissonian approach was applied during right hepatectomy. Preoperative imaging data were correlated with intraoperative Doppler ultrasound findings (considered as the reference dataset). Causes of failures and complications specifically related to the Glissonian approach were identified.
  
  
  RESULTS
  Right hepatectomy was performed for colorectal liver metastases (n = 25), hepatocellular carcinoma on cirrhosis (n = 6) and intrahepatic cholangiocarcinoma (n = 1). The Glissonian approach was effective in 24 (75%) patients. In the remaining eight (25%) patients, failure was caused by incomplete clamping (n = 2) or clamping of the left portal pedicle (n = 6). The portal anatomy was aberrant in six patients with failure, showing portal trifurcation (n = 1), right portal trifurcation (n = 1) and a common trunk between the right anterior and left portal branch (n = 4). An angle of less than 50° between the portal vein and left portal branch was reported in association with extended clamping to the left portal branch (selectivity = 72%, specificity = 71%). Intraoperative bleeding and biliary fistula occurred in two patients with non-normal portal anatomy.
  
  
  CONCLUSIONS
  The right Glissonian approach was effective in 75% of patients. Failure of the procedure (including the extension of clamping to the left pedicle) mostly occurred in patients with portal vein variations, which can be accurately assessed using a combination of preoperative imaging and intraoperative Doppler ultrasound.
authors: Department of Digestive Surgery, Amiens University Medical Centre, Amiens, France.
authors: Charlotte
authors: C
authors: Mouly
authors: David
authors: D
authors: Fuks
authors: François
authors: F
authors: Browet
authors: François
authors: F
authors: Mauvais
authors: Arnaud
authors: A
authors: Potier
authors: Thierry
authors: T
authors: Yzet
authors: Qassemyar
authors: Q
authors: Quentin
authors: Jean-Marc
authors: JM
authors: Regimbeau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000002:abnormalities / Q000000981:diagnostic imaging; D011172:Portography / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler