Hilar Glissonean Access in Laparoscopic Liver Resection

Laparoscopy for liver resection is a highly specialized field, as laparoscopic liver surgery presents severe technical difficulties. However, the recent rapid development of technological innovations, improvements in surgical skills and the accumulation of extensive experience by surgeons have improved the feasibility and safety of a laparoscopic approach for properly selected patients [1]. Since the first report of laparoscopic anatomical left lateral sectionectomy in 1996 [2], increasing numbers of laparoscopic anatomical liver resections have been reported [3-6]. However, laparoscopic anatomical resection has not been widely accepted because major technical difficulties remain, such as hilar dissection and pedicle control. During open anatomical liver resections, each Glissonean pedicle is often ligated and divided en bloc extrahepatically [7, 8]. Using the same concept, we describe herein a novel technique by which each Glissonean pedicle can be easily and safely encircled and divided en bloc extrahepatically during laparoscopic anatomical liver resection.