title: The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: Results of an observational study over 7 years.
abstract: This study compares the Glissonian approach with the standard approach to laparoscopic liver resection for safety and efficacy.
  
  
  
  The standard laparoscopic approach to anatomic liver resection is the dissection of the elements of the Glissonian pedicle below the hilar plate. In contrast, the Glissonian approach identifies the intrahepatic pedicles by tentative clamping. Concerns have been raised about the safety of the Glissonian approach in laparoscopic liver surgery. The study was performed to examine the initial 7 years of experience in a single center with regard to safety and efficacy.
  
  
  
  All consecutive patients undergoing laparoscopic liver resections from April 2007 to April 2014 at a single referral center for liver tumors were included. An observational comparison was performed between Glissonian and standard laparoscopic liver resections performed by the same team but during different eras. The primary endpoint was safety of the procedures as assessed by the recently published comprehensive complication index. Secondary endpoints were parameters of surgical efficacy, such as operating time, blood loss, blood transfusion, conversion rate, duration of hospitalization, and pathologic margin of the specimen.
  
  
  
  Between 2007 and 2014, 234 resections were performed laparoscopically at our institution, 120 using the conventional approach and 114 using the Glissonian approach. There was no difference in age, sex, tumor types, or comorbidities between the groups. The number of major liver resections was greater in the Glissonian group, yet there were fewer complications in the Glissonian group compared with the standard group (P < .05). Operative time was greater and more transfusions were given in the standard group; in addition, more patients had positive margins (P < .01). Overall hospital stay was less in the Glissonian group.
  
  
  
  In the 7-year experience of a single center, the Glissonian approach is not less safe and may seems to offer advantages when compared with the standard laparoscopic approach.
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil. Electronic address: dr@drmarcel.com.br.
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Surjan
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Basseres
authors.affiliation: Department of Surgery, Cantonal Hospital Winterthur and Institute of Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Erik
authors.initials: E
authors.lastname: Schadde
authors.affiliation: Division of Medical Oncology, Sirio Libanes Hospital, São Paulo, Brazil.
authors.forename: Frederico P
authors.initials: FP
authors.lastname: Costa
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.
authors.forename: Fábio F
authors.initials: FF
authors.lastname: Makdissi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome