Kim Ji Hoon, Kim Hyeyoung
Department of Surgery, Eulji University College of Medicine, Dunsan 2(i)-dong, Seo-gu, Daejeon, Republic of Korea.
J Gastrointest Surg. 2020 Dec;24(12):2904-2905. doi: 10.1007/s11605-020-04752-x. Epub 2020 Jul 31.
The Glissonean pedicle approach is a widely used technique in anatomical liver resection1. The Glissonean pedicle approach can be divided into the extrafacial approach (conventional Glissonean approach) and the transfissural approach2,3,4. We present pure laparoscopic anatomical segmentectomy in tertiary portal pedicles with anatomical variations and a deep location using the transfissural Glissonean approach.
According to the branching pattern of the tertiary portal pedicles, selection of the extrafascial or the transfissural approach was determined. The tertiary portal pedicles around the liver hilum can be dissected using the extrafascial approach. The transfissural approach was applied when the tertiary portal pedicles were multiple, variable, and located deep within the liver. These pedicles can be dissected after parenchymal transection along the fissure lines (resection of segment 6: right portal fissure; resection of segment 3: umbilical fissure).
Patients underwent anatomical resection of segments 6 (n = 8; extrafascial: 5; transfissural: 3) and 3 (n = 4; extrafascial: 1; transfissural: 3). The median operative time was 200 min (range 110-250 min), and the median blood loss was 100 mL (range 40-350 mL). The median tumor size was 18.5 mm (range 11-30 mm). All patients were negative resection margin. The median postoperative hospital stay was 5.5 days (range 4-8 days).
The tertiary portal pedicles can be dissected using the extrafascial or the transfissural approach. The transfissural approach in tertiary portal pedicles with anatomical variations and a deep location is a useful and effective method because opening the fissure lines allows direct access to these pedicles.
Glissone 蒂入路是解剖性肝切除中广泛应用的技术1。Glissone 蒂入路可分为肝外入路（传统 Glissone 入路）和经裂入路2,3,4。我们介绍了采用经裂 Glissone 入路对具有解剖变异和深部位置的三级门静脉蒂进行纯腹腔镜解剖性肝段切除术。
根据三级门静脉蒂的分支模式，确定选择肝外入路或经裂入路。肝门周围的三级门静脉蒂可采用肝外入路进行解剖。当三级门静脉蒂为多个、变异且位于肝深部时，采用经裂入路。这些门静脉蒂可在沿裂线进行实质离断后进行解剖（切除第 6 段：右门静脉裂；切除第 3 段：脐裂）。
患者接受了第 6 段（n = 8；肝外入路：5 例；经裂入路：3 例）和第 3 段（n = 4；肝外入路：1 例；经裂入路：3 例）的解剖性切除。中位手术时间为 200 分钟（范围 110 - 250 分钟），中位失血量为 100 毫升（范围 40 - 350 毫升）。中位肿瘤大小为 18.5 毫米（范围 11 - 30 毫米）。所有患者切缘阴性。中位术后住院时间为 5.5 天（范围 4 - 8 天）。
三级门静脉蒂可采用肝外入路或经裂入路进行解剖。对于具有解剖变异和深部位置的三级门静脉蒂，经裂入路是一种有用且有效的方法，因为打开裂线可直接显露这些门静脉蒂。
