Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach.

BACKGROUND: One of the main criticisms of laparoscopic liver resection is that it is difficult, or not possible, to perform liver-sparing resections. Our aim was to present short videos where the intrahepatic Glissonian approach was used to perform anatomical liver segmental resections, instead of a larger operation, to avoid unnecessary sacrifice of the liver parenchyma.

METHODS: We selected six types of anatomical liver resections to exemplify the use of the intrahepatic Glissonian approach to perform segment-oriented liver resections. These types of hepatectomies were used as an alternative to right or left hepatectomy, or as an alternative to extended liver resections.

RESULTS: The intrahepatic Glissonian approach was feasible in all cases. The use of anatomical landmarks previously described was essential to reach and control the Glissonian pedicles. Among the liver-sparing resections, we were able to perform right anterior (S5 + S8) and posterior (S6 + S7) sectionectomies, resection of segments 2, 3, and 4, and mesohepatectomy (S4 + S5 + S8). No patient presented postoperative liver failure.

CONCLUSIONS: Laparoscopic liver-sparing resections are feasible and may be a good alternative to hemihepatectomies or extended liver resections. The use of the intrahepatic Glissonian approach can be useful.