Pure Laparoscopic Anatomical Resection of the Ventral Area of the Right Anterior Section Using the Transfissural Glissonean Approach

Abstract

The introduction of the anatomical concept of classifying the right anterior section (RAS) into the ventral and dorsal areas enabled the development of limited resection of the ventral or dorsal area. Anatomical resection of the ventral area of the RAS is technically demanding because it requires determination of the boundary of the ventral area and two large of transection planes. We present a technique for laparoscopic anatomical resection of the ventral area of the RAS using a transfissural Glissonean approach.In the transfissural Glissonean approach, the portal or umbilical fissure is opened after liver parenchymal dissection, and then, the surgeon can confirm the Glissonean pedicles and territory. The procedure was as follows: (1) dissection of the right anterior portal pedicle (RAPP) for the identification of the main portal fissure, (2) opening of the main portal fissure, (3) dissection and clamping of the ventral branch of the RAPP, and (4) transection of the borderline of the ventral and dorsal areas.The transfissural Glissonean approach is a feasible and effective technique for laparoscopic anatomical resection of the ventral area of the RAS. Opening the main portal fissure allows easy and direct access to the ventral branch of the RAPP.