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Robotic extrahepatic Glissonean pedicle approach for anatomic liver resection in the right liver: techniques and perioperative outcomes

 Jin Ho Lee  ;  Dai Hoon Han  ;  Dong-Su Jang  ;  Gi Hong Choi  ;  Jin Sub Choi 
 Surgical Endoscopy , Vol.30(9) : 3882-3888, 2016 
Journal Title
 Surgical Endoscopy  
Issue Date
Adult ; Blood Loss, Surgical ; Carcinoma, Hepatocellular/surgery ; Female ; Hepatectomy/methods* ; Humans ; Laparoscopy* ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Operative Time ; Robotic Surgical Procedures*
Anatomic resection ; Glissonean approach ; Robotic liver resection
BACKGROUND: The Glissonean pedicle approach is one of the most popular methods of anatomic liver surgery. Liver surgeons have attempted to reproduce this method laparoscopically. In this study, we introduce our technique of the extrahepatic Glissonean approach for anatomic liver resections, using a robotic system, and report on short-term perioperative outcomes. METHODS: From December 2008 to July 2014, 10 patients underwent robotic anatomic liver resection in the right liver. The procedure is as follows: (1) mobilization of the liver and isolation and clamping of a selected Glissonean pedicle; (2) transection of the liver parenchyma using a rubber band retraction technique; (3) division of the Glissonean pedicle after full exposure, followed by completion of parenchymal transection. RESULTS: The median age of the patients was 52.50 (range 28-59) years, and seven were male. All patients had hepatocellular carcinoma. The types of resections performed were as follows: segmentectomy 6 (n = 1), segmentectomy of 4b + 5 ventral segments (n = 2), right posterior sectionectomy (n = 3), extended right hepatectomy (n = 1), extended right posterior sectionectomy (n = 2), and central bisectionectomy (n = 1). Only one case was converted to open surgery due to severe tumor adhesions on the diaphragm. The median operative time was 555 min (range 413-848), and the median estimated blood loss was 225 ml (range 30-700), with no perioperative transfusions. The overall complication rate was 70 % (grade I, 5; grade II, 1; grade III, 1; grade IV, 0). The median length of hospital stay postsurgery was 7 days (range 6-11). CONCLUSION: Robotic surgery allowed for successful anatomic liver resections via an extrahepatic Glissonean pedicle approach in the right liver and can be safely performed in selected patients.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
최기홍(Choi, Gi Hong) ORCID logo https://orcid.org/0000-0002-1593-3773
최진섭(Choi, Jin Sub)
한대훈(Han, Dai Hoon) ORCID logo https://orcid.org/0000-0003-2787-7876
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