Pure Laparoscopic Anatomical Resection of Segment 4b for Hepatocellular Carcinoma Using the Transfissural Glissonean App
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MULTIMEDIA ARTICLE
Pure Laparoscopic Anatomical Resection of Segment 4b for Hepatocellular Carcinoma Using the Transfissural Glissonean Approach Ji Hoon Kim 1,2
&
Hyeyoung Kim 1
Received: 3 April 2020 / Accepted: 29 April 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Anatomical segmentectomy is a technically challenging procedure because tertiary portal pedicles are multiple, variable, and deep inside the liver.1 Anatomical segmentectomy can be performed using the transfissural Glissonean approach through the opening main portal fissure or umbilical fissure.1–3 We present laparoscopic anatomical resection of segment 4b using the transfissural Glissonean approach. Methods A 67-year-old man was referred for treatment of single nodular mass in segment 4b. The surgical procedure involved the following steps: (1) Opening of the umbilical fissure along the umbilical fissure vein (2) Dissection of Glissonean pedicle 4b (3) Identification of ischemic territory of segment 4b (4) Right-side parenchymal transection along the ischemic line. Results The operative time was 230 min, and the estimated blood loss was 100 mL. The final histopathological diagnosis was hepatocellular carcinoma. The tumor size was 30 mm and the resection margin was 25 mm. The patient had an uneventful postoperative recovery, and he was discharged on postoperative day 6. Conclusion The transfissural Glissonean approach for laparoscopic anatomic resection of segment 4 b is a feasible and effective technique. The opening of the umbilical fissure allows the surgeon to dissect the target portal pedicles of segment 4b directly. Keywords Laparoscopic liver resection . Anatomical liver resection . Segmentectomy . Glissonean approach
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04637-z) contains supplementary material, which is available to authorized users.
Author’s Contribution Ji Hoon Kim: Study conception and design, Acquisition of data, Analysis and interpretation of data, Drafting of manuscript, and Critical revision; Hyeyoung Kim: Critical revision.
* Ji Hoon Kim [email protected]
Compliance with Ethical Standards
1
Department of Surgery, Eulji University College of Medicine, Daejeon, Republic of Korea
2
Department of Surgery, Eulji University Hospital, Dunsan 2(i)-dong, Daejeon, Seo-gu, Republic of Korea
Conflict of Interest Dr. Ji Hoon Kim and Hyeyoung Kim have no conflicts of interest. Funding No Funding.
J Gastrointest Surg
References 1. 2.
Couinaud C. Surgical anatomy of the liver revisited. Selfprinted, Paris, France, 1989:29–48. Kim JH. Pure laparoscopic anatomical resection of the ventral area of the right anterior section using the transfissural Glissonean approach. J Gastrointest Surg. 2019;23:1279–82.
3.
Kim JH, Kim H. Pure Laparoscopic Anatomic Resection of the Segment 8 Ventral Area Using the Transfissural Glissonean Approach. Ann Surg Oncol. 2019;26:4608-4609.
Publisher’s Note Springer Nature remains neutral with regard to ju
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