The extraglissionian approach for laparoscopic right hemihepatectomy

Abstract

Background: Different techniques are used in laparoscopic liver surgery. While these techniques are mainly determined by the lesion itself (location, size) there are choices for standard anatomical resections such as right hemihepatectomy. In selected patients the extraglissonian approach can be used in order to facilitate laparoscopic resection. Methods: This video shows a fully laparoscopic right hemihepatectomy using the extraglissonian approach avoiding the time consuming individual dissection of the hilar structures: right bile duct artery and portal vein branch as used in the intraglissonian approach. Results: The extraglissionian approach requires a good visualization of the entire right pedicle which must be encircled before devascularizing the entire right hemiliver using one stapler. If the secure identification of the right pedicle cannot be obtained this technique can not be used. Conclusion: Similar to the technique used in left lateral resection, the entire right pedicle may be transsected using a stapler during laparoscopic right hemihepatectomy (extraglissionian approach).