Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach

Background. One of the main criticisms of laparoscopic liver resection is that it is difficult, or not possible, to perform liver-sparing resections. Our aim was to present short videos where the intrahepatic Glissonian approach was used to perform anatomical liver segmental resections, instead of a larger operation, to avoid unnecessary sacrifice of the liver parenchyma. Methods. We selected six types of anatomical liver resections to exemplify the use of the intrahepatic Glissonian approach to perform segment-oriented liver resections. These types of hepatectomies were used as an alternative to right or left hepatectomy, or as an alternative to extended liver resections. Results. The intrahepatic Glissonian approach was feasible in all cases. The use of anatomical landmarks previously described was essential to reach and control the Glissonian pedicles. Among the liver-sparing resections, we were able to perform right anterior (S5 + S8) and posterior (S6 + S7) sectionectomies, resection of segments 2, 3, and 4, and mesohepatectomy (S4 + S5 + S8). No patient presented postoperative liver failure. Conclusions. 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.