Skip to main content
SpringerLink
Log in

Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere’s sulcus as a landmark, and a modified liver hanging maneuver (with video)

  • How-I-Do-It Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Pure laparoscopic anatomical segmental resection has rarely been reported because this technique frequently presents technical difficulties. We describe the laparoscopic resection of anatomical segment VI using the Glissonian approach and a modified liver hanging maneuver.

Methods

Rouviere’s sulcus is identified after retracting superiorly the gallbladder. The Glissonian approach for anatomical resection of segment VI can be performed with minimal dissection of the liver parenchyma around the sulcus. After clamping the Glissonian pedicle in the sulcus, the ischemic area fed by the portal pedicle was confirmed. The right triangular ligament was divided to create a small opening for placement of the hanging tape along the ischemic line. The liver parenchymal transection was performed along the hanging tape.

Results

Four patients underwent pure laparoscopic anatomical segment VI resection using the Glissonian approach and a modified liver hanging maneuver. The median operation time was 205 min (range, 110–250 min), and median estimated blood loss was 110 mL (range, 100–350 mL). The median postoperative hospital stay was 5 days (range, 4–8 days). There was no postoperative morbidity or mortality.

Conclusion

The Glissonian approach at Rouviere’s sulcus as a landmark combined with the modified liver hanging maneuver may be safe and useful for laparoscopic anatomical segment VI resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250(5):831–841. https://doi.org/10.1097/SLA.0b013e3181b0c4df

    Article  PubMed  Google Scholar 

  2. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629. https://doi.org/10.1097/SLA.0000000000001184

    PubMed  Google Scholar 

  3. Ahn KS, Han HS, Yoon YS, Cho JY, Kim JH (2011) Laparoscopic anatomical S5 segmentectomy by the Glissonian approach. J Laparoendosc Adv Surg Tech A 21(4):345–348. https://doi.org/10.1089/lap.2010.0550

    Article  PubMed  Google Scholar 

  4. Kim YK, Han HS, Yoon YS, Cho JY, Lee W (2015) Total anatomical laparoscopic liver resection of segment 4 (s4), extended s4, and subsegments s4a and s4b for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 25(5):375–379. https://doi.org/10.1089/lap.2014.0443

    Article  PubMed  Google Scholar 

  5. Liau K, Blumgart L, DeMatteo R (2004) Segment-oriented approach to liver resection. Surg Clin North Am 84(2):543–561. https://doi.org/10.1016/j.suc.2003.12.003

    Article  CAS  PubMed  Google Scholar 

  6. Takasaki K (1998) Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepato-Biliary-Pancreat Surg 5(3):286–291. https://doi.org/10.1007/s005340050047

    Article  CAS  Google Scholar 

  7. Gans H (1995) The anatomy of the intrahepatic structures and its repercussions on surgery. Elsevier, Amsterdam, pp 65–91

    Google Scholar 

  8. Dahmane R, Morjane A, Starc A (2013) Anatomy and surgical relevance of Rouviere’s sulcus. Sci World J 2013:254287. https://doi.org/10.1155/2013/254287

    Article  Google Scholar 

  9. Cho JY, Han HS, Yoon YS, Choi Y, Lee W (2015) Outcomes of laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery. Surgery 158(1):135–141. https://doi.org/10.1016/j.surg.2015.02.007

    Article  PubMed  Google Scholar 

  10. Kim JH, Ryu DH, Jang LC, Choi JW (2016) Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections. Surg Endosc 30(8):3611–3617. https://doi.org/10.1007/s00464-015-4663-2

    Article  PubMed  Google Scholar 

  11. Kim JH, Choi JW (2017) A modified liver hanging maneuver in pure laparoscopic left hemihepatectomy with preservation of the middle hepatic vein: video and technique. J Gastrointest Surg 21(7):1181–1185. https://doi.org/10.1007/s11605-017-3369-2

    Article  PubMed  Google Scholar 

  12. Berardi G, Van Cleven S, Fretland ÅA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of laparoscopic liver surgery from innovation to implementation to mastery: perioperative and oncologic outcomes of 2,238 patients from 4 European specialized centers. J Am Coll Surg 225(5):639–649. https://doi.org/10.1016/j.jamcollsurg.2017.08.006

    Article  PubMed  Google Scholar 

  13. Sugioka A, Kato Y, Tanahashi Y (2017) Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci 24(1):17–23. https://doi.org/10.1002/jhbp.410

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mizuno T, Sheth R, Yamamoto M, Kang HS, Yamashita S, Ta A, Chun YS, Lee JE, Vauthey JN, Conrad C (2016) Laparoscopic Glissonean pedicle transection (Takasaki) for negative fluorescent counterstaining of segment 6. Ann Surg Onc doi 24(4):1046–1047. https://doi.org/10.1245/s10434-016-5721-2

    Article  Google Scholar 

  15. Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B (2014) Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 218:e37–41. https://doi.org/10.1016/j.jamcollsurg.2013.10.022

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine, Eulji University, Daejeon, Republic of Korea

    Ji Hoon Kim, Byung Sun Cho & Je-Ho Jang

Authors
  1. Ji Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Byung Sun Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Je-Ho Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Ji Hoon Kim. Acquisition of data: Ji Hoon Kim, Je-Ho Jang. Analysis and interpretation of data: Ji Hoon Kim. Drafting of the manuscript: Ji Hoon Kim. Critical revision of the manuscript: Ji Hoon Kim, Byung Sun Cho

Corresponding author

Correspondence to Ji Hoon Kim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.H., Cho, B.S. & Jang, JH. Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere’s sulcus as a landmark, and a modified liver hanging maneuver (with video). Langenbecks Arch Surg 403, 131–135 (2018). https://doi.org/10.1007/s00423-018-1652-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-018-1652-7

Keywords

Search

Navigation