Feasibility of the Glissonian approach during right hepatectomy

Mouly, C.; Fuks, David; Browet, F.; Mauvais, F.; Potier, A.; Yzet, T.; Qassemyar, Q.; Régimbeau, Jean-Marc

doi:10.1111/hpb.12035

Cited by 25 publications

(38 citation statements)

References 23 publications

(44 reference statements)

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“…). The Madoff classification (Madoff et al, ) was preferred to those proposed by Nakamura et al () and Cheng et al (), since this classification was used in the study by Mouly et al () to define anatomical variations associated with a risk of right Glissonian pedicle clamping failure. According to the series published by Mouly et al (), the angle between the portal vein and the left portal vein was also measured on 3‐dimensional reconstructions using three radiological markers: middle of the portal vein, portal bifurcation and middle of the left portal vein.…”

Section: Methodsmentioning

confidence: 99%

“…Failure of right Glissonian pedicle clamping according to Mouly et al () is defined as clamping extended to the left portal vein or incomplete right portal vein clamping. In this study, Types 1 to 3 variations are associated with an increased risk of right Glissonian pedicle clamping failure, while Type 4 variation is not associated with an increased risk of clamping failure.…”

Section: Methodsmentioning

confidence: 99%

“…In this study, Types 1 to 3 variations are associated with an increased risk of right Glissonian pedicle clamping failure, while Type 4 variation is not associated with an increased risk of clamping failure. An angle between the portal trunk and the left portal vein less than 50°, in the presence of normal anatomy, also appears to be associated with a risk of failure of Glissonian pedicle clamping due to extension of clamping to the left portal vein (Mouly et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…Figueras et al () and Giordano et al (), in two randomized control trials, demonstrated the safety of this technique, which is associated with few complications and 100% feasibility. In a more recent prospective study comprising 32 patients undergoing right hepatectomy, Mouly et al () showed that this technique was feasible in only 75% of cases and identified modified anatomy of the right Glissonian pedicle as the cause of failure.…”

Section: Introductionmentioning

confidence: 99%

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Portal vein variants associated with right hepatectomy: An analysis of abdominal CT angiography with 3D reconstruction

et al. 2019

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Glissonian approach has been described as a selective vascular clamping procedure during hepatectomy based on external anatomical landmarks. Anatomical variations of the right Glissonian pedicle have been identified with an increased risk of clamping failure during Glissonian approach. The objective of this study was to characterize the anatomical variations of the right Glissonian pedicle at risk of clamping failure during right hepatectomy. This was a retrospective analysis of abdominal multiphasic CT and routine 3D reconstruction (n = 346). Anatomical variations at risk of clamping failure were Types 1 to 3 (Madoff's classification) and an angle of less than 50 between the portal vein and the left portal vein. Primary objective was the risk of right Glissonian pedicle clamping failure. Secondary objectives were the rate of normal anatomy, the rate of variations, and the rate of incomplete or extended clamping. Normal anatomy was found in 245 patients (71%). Anatomical variations were as follows: Type 1: 11%, Type 2: 17%, Type 3: 0.8%, Type 4: 0%. Angle variation less than 50 was observed in 4.5%. The risk of selective clamping failure was 34%. Extension of clamping was observed in 16%, while incomplete clamping was observed in 17.8%. Failure of right Glissonian pedicle clamping was predictable in 34% of cases while 71% of patients presented normal portal vein anatomy. Clin. Anat. 32:328-336, 2019.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Portal vein variants associated with right hepatectomy: An analysis of abdominal CT angiography with 3D reconstruction

et al. 2019

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“…The success of the approach is often dependent on vascular anatomy. 113 Portal vein ligation and in-situ splitting of the liver, referred to as associating liver partition and portal vein ligation for staged hepatectomy, promotes rapid liver regeneration and was newly introduced for the “small-for-size” setting. 110 However, this technique is associated with substantial morbidity and mortality and needs further evaluation.…”

Section: Perihilar Cholangiocarcinomamentioning

confidence: 99%

Cholangiocarcinoma

Razumilava¹,

Gores²

2014

The Lancet

1,458

1,314

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Cholangiocarcinoma represents a diverse group of epithelial cancers united by late diagnosis and poor outcomes. Specific diagnostic and therapeutic approaches are undertaken for cholangiocarcinomas of different anatomical locations (intrahepatic, perihilar, and distal). Mixed hepatocellular cholangiocarcinomas have emerged as a distinct subtype of primary liver cancer. Clinicians need to be aware of intrahepatic cholangiocarcinomas arising in cirrhosis and properly assess liver masses in this setting for cholangiocarcinoma. Management of biliary obstruction is obligatory in perihilar cholangiocarcinoma, and advanced cytological tests such as fluorescence in-situ hybridisation for aneusomy are helpful in the diagnosis. Liver transplantation is a curative option for selected patients with perihilar but not with intrahepatic or distal cholangiocarcinoma. International efforts of clinicians and scientists are helping to identify the genetic drivers of cholangiocarcinoma progression, which will unveil early diagnostic markers and direct development of individualised therapies.

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Application and utility of surgical techniques for cystic plate isolation in liver surgery

Tokumitsu

Tamesa

Shindo

et al. 2022

Annals of Gastroent Surgery

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Surgical techniques for liver cancers have advanced considerably with increased anatomical knowledge of the plate system in the hilar area.There are four plates in the hilar area: the hilar plate, the cystic plate, the umbilical plate, and the Arantian plate. At the hilum, all variations in bile ducts and blood vessels occur within the hilar plate, and these branches penetrate the plate system and form Glisson's capsule. Thus, proper isolation of the plate system can bring about developments in the era of widespread liver surgery, including minimally invasive surgery.The cystic plate is a sheet of fibroareolar tissue located in the gallbladder bed. Isolation of the cystic plate appears applicable to

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Feasibility of the Glissonian approach during right hepatectomy

Cited by 25 publications

References 23 publications

Portal vein variants associated with right hepatectomy: An analysis of abdominal CT angiography with 3D reconstruction

Portal vein variants associated with right hepatectomy: An analysis of abdominal CT angiography with 3D reconstruction

Cholangiocarcinoma

Application and utility of surgical techniques for cystic plate isolation in liver surgery

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