Intrahepatic Glissonian Approach in laparoscopic Right Hepatectomy

Laparoscopic surgery is still uncommon for major liver resections. The intrahepatic Glissonian approach is a fast and secure way to control the hepatic pedicle. A patient diagnosed with stenosing sigmoid adenocarcinoma (T3 N1 M+) (N+, positive lymph nodes, M+ positive metastatic desease)with synchronous liver metastases in segments 7 (8 mm), 6-7 (6 cm) and 3 (12 mm) was recruited to the study. Laparoscopic sigmoidectomy was performed; after a partial response to neoadjuvant chemotherapy, a right hepatectomy was performed. Surgery was performed in the modified Lloyd Davies position by placing 5 trocars. The hepatic pedicle was controlled by the intrahepatic individualized section of the right Glissonian anterior and posterior pedicles. The operation lasted for 5 hours. No intraoperative or postoperative complications occurred. The patient was discharged from the hospital on the fourth postoperative day. The final histopathology showed metastatic colorectal adenocarcinoma in segments 6-7 with right hepatic vein involvement and tumor-free margins. Although this approach is beneficial, it should be performed by experienced surgeons. We believe that this technique is faster, safer, easier and more reproducible than hilar dissection. This approach can help develop the use of minimally invasive surgery for major liver resections.