Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach

Machado, Marcel Autran; Surjan, Rodrigo C.; Bassères, T.; Makdissi, Fábio F.

doi:10.1245/s10434-017-5886-3

Cited by 9 publications

(15 citation statements)

References 6 publications

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“…These findings are particularly important in the age of laparoscopy with the growing rates of laparoscopic liver resection worldwide. The laparoscopic Glissonian approach has been described as a safe, efficient, and reproducible technique (Topal et al, ; Machado et al, ). Machado et al () reported their 7‐year experience of laparoscopic liver resection and showed that the Glissonian approach is safer and more effective than the standard approach with a shorter operating time, decreased blood loss (fewer transfusions), increased complete resections, and a shorter length of hospital stay .…”

Section: Discussionmentioning

confidence: 99%

“…However, in the light of the findings of this series, the laparoscopic Glissonian approach should be performed cautiously in patients with abnormal portal venous variants (Machado et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The Glissonian approach is a suprahilar/extrafascial selective vascular clamping technique providing access to all Glissonian pedicles on the inferior surface of the liver using seven external landmarks defined by Machado et al () and using a modified hilar plate technique (Regimbeau and Mauvais, ; Chapuis‐Roux et al, ).…”

Section: Methodsmentioning

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…42,43 Of note, several reports have demonstrated the feasibility and safety of MIS right or left hepatectomy via Glissonian. [44][45][46][47][48][49][50][51][52][53] The Glissonian approach can even be applied to other types of MIS hepatic resections including single-segment resection of S2, S5, and S6, as well as mesohepatectomy (segments 4, 5, and 8) with no procedure-related complications. [45][46][47]54,55 Notably, Machado et al has reported on almost every type of MIS liver resection using an intrahepatic Glissonian approach including left single segmentectomies (S1, S2, S3, S4), left bi-segment ectomies (S2-S3), ri ght bisegmentectomies (S5-S8, S6-S7, S7-S8), left and right hemih e p a t e c t o m i e s , r i g h t t r i -s e c t i o n e c t o m i e s , a n d mesohepatectomies.…”

Section: Glissonian Approach and Laparoscopic Liver Surgerymentioning

confidence: 99%

“…[45][46][47]54,55 Notably, Machado et al has reported on almost every type of MIS liver resection using an intrahepatic Glissonian approach including left single segmentectomies (S1, S2, S3, S4), left bi-segment ectomies (S2-S3), ri ght bisegmentectomies (S5-S8, S6-S7, S7-S8), left and right hemih e p a t e c t o m i e s , r i g h t t r i -s e c t i o n e c t o m i e s , a n d mesohepatectomies. [48][49][50][51][52][53] Machado and colleagues have also demonstrated the feasibility and safety of single-port MIS left lateral sectionectomy without any postoperative morbidity or mortality. 56 In a 7-year observational study, MIS intrahepatic Glissonian approach was noted to have several advantages over standard MIS resection including shorter operative time, lower transfusion rates, fewer patients with a postoperative positive margin, as well as less morbidity and a shorter duration of hospital stay.…”

Section: Glissonian Approach and Laparoscopic Liver Surgerymentioning

confidence: 99%

Updates and Critical Insights on Glissonian Approach in Liver Surgery

Moris

Rahnemai‐Azar

Tsilimigras

et al. 2018

Journal of Gastrointestinal Surgery

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Recent advances in surgical techniques have broadened the indications of surgical management of liver malignancies. Intraoperative bleeding is one of the known predictors of postoperative outcomes following liver surgery, signifying the importance of vascular control during liver resection. Furthermore, preservation of future liver remnant plays a critical role in prevention of post-hepatectomy liver failure as one of the main causes of postoperative morbidity and mortality. Glissonian approach liver resection offers an effective method for vascular inflow control while protecting future liver remnant from ischemia-reperfusion injury. Several studies have demonstrated the feasibility of Glisson's pedicle resection technique in modern liver surgery with an acceptable safety profile. Moreover, with increasing popularity of minimally invasive surgery, laparoscopic liver resection via Glissonian approach has been shown to be superior to standard laparoscopic hepatectomy. Herein, we systematically review the role of Glissonian approach hepatectomy in current practice of liver surgery, highlighting its advantages and disadvantaged over other methods of vascular control.

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Glissonean approach for hepatic inflow control in minimally invasive anatomic liver resection: A systematic review

Morimoto

Tomassini

Berardi

et al. 2021

J Hepato Biliary Pancreat

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Background:The Glissonean approach has been widely validated for both open and minimally invasive anatomic liver resection (MIALR). However, the possible advantages compared to the conventional hilar approach are still under debate. The aim of this systematic review was to evaluate the application of the Glissonean approach in MIALR. Methods: A systematic review of the literature was conducted on PubMed and Ichushi databases. Articles written in English or Japanese were included. From 2,390 English manuscripts evaluated by title and abstract, 43 were included. Additionally, 23 out of 463 Japanese manuscripts were selected. Duplicates were removed, including the most recent manuscript. Results: The Glissonean approach is reported for both major and minor MIALR. The 1st, 2nd and 3rd order divisions of both right and left portal pedicles can be reached How to cite this article: Morimoto M, Tomassini F, Berardi G, et al. Glissonean approach for hepatic inflow control in minimally invasive anatomic liver resection: A systematic review.

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Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach

Abstract: Laparoscopic liver-sparing resections are feasible and may be a good alternative to hemihepatectomies or extended liver resections. The use of the intrahepatic Glissonian approach can be useful.

Cited by 9 publications

References 6 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

Updates and Critical Insights on Glissonian Approach in Liver Surgery

Glissonean approach for hepatic inflow control in minimally invasive anatomic liver resection: A systematic review

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