Intrahepatic Glissonean Pedicle Approach by Dividing the Liver along the Middle Hepatic Vein from the Cranial Side during Laparoscopic Anatomic Liver Resection of Segment 8

Yusuke Ome, MD; Goro G. Honda, MD, PhD, FACS; Jun Yamamoto, MD; Manami Doi, MD; Yuki Y. Homma, MD

Product Details
Product ID: ACS-5599
Year Produced: 2018
Length: 9 min.


Laparoscopic anatomic resection of S8 (Lap-S8) is regarded as technically difficult because of its anatomical position and the diversity of the branching pattern of the Glissonean pedicles of S8 (G8). We have standardized a safe approach to G8 and the major hepatic veins from the cranial side making use of the laparoscopic view. In extrahepatic G8 isolation from the hepatic hilum, the distance of the exposed right anterior Glissonean pedicle and G5 that must be preserved becomes longer; thus, there is an increased risk of biliary leakage and delayed biliary stricture, due to excessive traction and dissection in laparoscopic surgery. Furthermore, it is sometimes technically difficult to secure G8 from the hepatic hilum, depending on its branching pattern. Therefore, we identify and approach G8 intrahepatically after parenchymal transection along the middle hepatic vein (MHV) running on the intersegmental plane from the root side to the peripheral side via intercostal trocars, referring to the preoperative simulation by 3D imaging and intraoperative ultrasonography. G8 is typically detected on the right dorsal side of the MHV. The liver parenchyma is dissected along the demarcation line of the ischemic area of S8 after transiently clamping G8, and G8 is divided. The right hepatic vein is also exposed from the root side to the peripheral side, with the resected S8 pushed upwards to the right ventral side. Subsequently, the parenchyma between the demarcation line on the liver surface and the right hepatic vein is divided from inside to outside, and Lap-S8 is completed.