Laparoscopic Right Hemihepatectomy Using the Glissonean Approach: Detachment of the Hilar Plate (with Video).

Abstract

The Glissonean approach is a fundamental technique for anatomical liver resection using both open and laparoscopic surgery. After detachment of the hilar plate from the liver parenchyma, the right Glissonean pedicle can be easily approached. This study describes the technical details and surgical outcomes of laparoscopic right hemihepatectomy using the Glissonean approach through the detachment of the hilar plate. The key procedures of our technique were as follows: Step (1) Incision of the peritoneum between segment 4 and the superior surface of the hilar plate, Step (2) Division of the posterior extremity of the cystic plate, Step (3) Incision of the peritoneum between the caudate process and the inferior surface of the hilar plate, Step (4) Clamping of the right Glissonean pedicle after partial detachment of the hilar plate, Step (5) Transection of the right Glissonean pedicle during the parenchymal transection. Between May 2013 and December 2019, 13 patients underwent laparoscopic right hemihepatectomy using the Glissonean approach. The median operation time was 280min (range 200-410min), and the median blood loss was 310ml (range 120-600ml). The median postoperative hospital stay was 8days (range 7-25days). There were no biliary complications. The detachment of the hilar plate was a feasible and effective technique in laparoscopic right hemihepatectomy using the Glissonean approach. Our standardized technique prevents biliary complications by meticulous dissection of potential injury sites related to the hilar plate.