Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere's sulcus as a landmark, and a modified liver hanging maneuver (with video)

Pure laparoscopic anatomical segmental resection has rarely been reported because this technique frequently presents technical difficulties. We describe the laparoscopic resection of anatomical segment VI using the Glissonian approach and a modified liver hanging maneuver. Rouviere's sulcus is identified after retracting superiorly the gallbladder. The Glissonian approach for anatomical resection of segment VI can be performed with minimal dissection of the liver parenchyma around the sulcus. After clamping the Glissonian pedicle in the sulcus, the ischemic area fed by the portal pedicle was confirmed. The right triangular ligament was divided to create a small opening for placement of the hanging tape along the ischemic line. The liver parenchymal transection was performed along the hanging tape. Four patients underwent pure laparoscopic anatomical segment VI resection using the Glissonian approach and a modified liver hanging maneuver. The median operation time was 205 min (range, 110-250 min), and median estimated blood loss was 110 mL (range, 100-350 mL). The median postoperative hospital stay was 5 days (range, 4-8 days). There was no postoperative morbidity or mortality. The Glissonian approach at Rouviere's sulcus as a landmark combined with the modified liver hanging maneuver may be safe and useful for laparoscopic anatomical segment VI resection.