Department of Surgery, Eulji University College of Medicine, Daejeon, Republic of Korea.
Department of Surgery, Eulji University Hospital, Daejeon, Republic of Korea.
Ann Surg Oncol. 2019 Dec;26(13):4608-4609. doi: 10.1245/s10434-019-07852-4. Epub 2019 Oct 3.
Pure laparoscopic anatomic resection of liver segment 8 still is rarely performed due to technical difficulties and the anatomic complexity.12 Limited resection of the segment 8 ventral area has been possible because the right anterior section can be divided into ventral and dorsal areas.34 This report describes the technique of pure laparoscopic anatomic resection of the segment 8 ventral area using the transfissural Glissonean approach.
A 43-year-old woman who had been taking oral contraceptives for 3 years was referred for treatment of a single nodular tumor located in the segment 8 ventral area. The surgical procedure involved the following steps: (1) dissection and clamping of the right Glissonean pedicle, (2) identification of the main portal fissure, (3) parenchymal dissection along the main portal fissure,58 (4) dissection and ligation of the segment 8 ventral portal pedicle, and (5) transection of the ischemic demarcation line of the segment 8 ventral area.
The operative time was 180 min, and the estimated blood loss was 30 mL. The total Pringle maneuver time was 45 min. The final histopathologic diagnosis was an adenoma. The tumor size was 6 mm, and the resection margin was negative. The patient had an uneventful postoperative recovery, and she was discharged on postoperative day 3.
The transfissural Glissonean approach for laparoscopic anatomic resection of the segment 8 ventral area is a feasible and effective technique. Opening of the main portal fissure allows easy and direct access to the segment 8 ventral branch.
由于技术难度和解剖复杂性，纯腹腔镜解剖性肝 8 段切除术仍很少进行。12 由于可以将右前叶分为腹侧和背侧区域，因此已经可以对 8 段腹侧区域进行有限切除。34 本报告介绍了使用经裂腔 Glisson 入路行纯腹腔镜解剖性 8 段腹侧区域切除术的技术。
一名 43 岁女性因口服避孕药 3 年，发现单发结节性肿瘤位于 8 段腹侧区域，前来就诊。手术步骤如下：（1）解剖和夹闭右 Glisson 蒂；（2）识别主门脉裂；（3）沿主门脉裂进行肝实质解剖；58（4）解剖和结扎 8 段腹侧门脉蒂；（5）横断 8 段腹侧区域缺血界限线。
手术时间为 180 分钟，估计失血量为 30 毫升。总阻断时间为 45 分钟。最终的组织病理学诊断为腺瘤。肿瘤大小为 6 毫米，切缘阴性。患者术后恢复顺利，术后第 3 天出院。
经裂腔 Glisson 入路行腹腔镜解剖性 8 段腹侧区域切除术是一种可行且有效的技术。主门脉裂的切开可方便直接进入 8 段腹侧支。
