The Glissonian pedicle approach and short-term outcomes of the laparoscopic anatomical liver resection

Background:
Laparoscopic anatomical liver resection is technically challenging, especially in the Glissonian pedicle approach.
Methods:
We developed the cystic plate traction method to encircle the first and second blanch of the right-sided Glissonian pedicle. At first, whole layer cholecystectomy without cutting of the cystic plate is performed, and then we give the cystic plate traction. This procedure provides a clear view of the border between hilar plate and liver parenchyma, and the Glissonian pedicle can be encircled safety. When encircling the third branch, fine parenchymal dissections around the target Glissonian pedicle are performed to avoid injury of proximal blanch. The left-sided Glissonian pedicle can be also encircled easily after fine parenchymal dissections.
Result:
Twenty-eight patients underwent anatomical resection from 2016 to 2020, and 16 had segmentectomy  (S2: 2 cases , S3+S8: 1 case, S4a+5: 1 case, S5: 5 cases, S6: 2 cases, S7: 1 case, S8: 4 cases), 6 had sectionectomy (medial: 3 cases, anterior: 2 cases, posterior: 1case), and 6 had hemi-hepatectomy (Left: 4 cases, Right: 2 cases). Median operation time was 586 min, blood loss was 400 ml, and postoperative stay was 17.5 days. Postoperative bile leakages were observed in 3 cases, and no postoperative mortality was observed.
Conclusion:
Laparoscopic anatomical liver resection can be achieved safety using the technique for the Glissonian pedicle approach.