Laparoscopic right hepatectomy using hanging maneuver and Glissonian approach
Epublication WebSurg.com, Dec 2014;14(12). URL: http://websurg.com/doi/vd01en4383
Background: In open surgery for major hepatectomies, the Glissonian approach and liver hanging maneuver have proven useful. However, these techniques are not routinely applied in a laparoscopic context due to some intrinsic difficulty. Published techniques for laparoscopic major hepatectomy generally involve hilar dissection with separate transection of vasculo-biliary elements and anatomical parenchymal transection along the demarcation line. This video demonstrates the feasibility of the Glissonian approach and liver hanging maneuver that were performed for total laparoscopic right hepatectomy. Methods: A 57-year-old woman suffering from huge liver mass was referred for surgical treatment. A total laparoscopic right hepatectomy was performed for this lesion. The operation followed 5 distinct phases: early hanging maneuver, extrahepatic extrafascial access to the right portal pedicle, parenchymal transection, control and division of the right hepatic vein, and complete mobilization of the right liver. Results: Operative time was 400 min. The estimated blood loss was 150mL and no need for blood transfusion. The pathological examination confirmed an 8 by 6 by 7cm HCC with clear surgical margins. Patient recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusions Glissonian approach and hanging maneuver have proven to be safe and useful procedures for performing precise laparoscopic right hepatectomy.