TECHNIQUE Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach

Background Recent advances in laparoscopic techniques have resulted in growing indications for laparoscopic hepatectomy. However, this procedure has not been widely developed, and anatomic segmental liver resection is not currently performed due to difficulty controlling the seg-mental Glissonian pedicles laparoscopically. This study aimed to report a novel technique for laparoscopic ana-tomic resection of left liver segments using the intrahepatic Glissonian approach based on small incisions according to anatomic landmarks such as Arantius ’ and round ligaments. Methods Nine consecutive patients underwent laparo-scopic liver resection using the intrahepatic Glissonian technique from April 2007 to June 2008. Five patients underwent laparoscopic bisegmentectomy 2–3, one lapa-roscopic left hemihepatectomy, two resections of segment 3, and one resection of segment 4. Results One patient required a blood transfusion. The mean operation time was 180 min (range, 120–300 min), and the median hospital stay was 3 days (range, 1–5 days). No patient had postoperative signs of liver failure or bile leakage. No postoperative mortality was observed. Conclusion The main advantage of the intrahepatic Glissonian procedure over other techniques is the possi-bility of gaining a rapid and precise access to the left Glissonian sheaths facilitating left hemihepatectomy, bisegmentectomy 2–3, and individual resections of seg-ments 2, 3, and 4. The authors believe that the intrahepatic Glissonian technique facilitates laparoscopic liver resection and may increase the development of segment-based lap-aroscopic liver resection