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( Sam-youl Yoon ),( Hyung-jun Han ),( Yun-song Go ),( Tae-jin Song ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Purpose: Glissonian approach is useful method in open hepatic resection. Glisonian approach have benefit of less blood loss, operation time saving and better oncologic outcomes. Totally intra-corporeal laparoscopic Rt. Posterior Sectionectomy is difficult to challenge and dangerous to surgeons on his initial stage for laparoscopic liver resection. Laparoscopic Glissonian approach with hanging-over maneuver is could be achived by isolation of Rt. Posterior Glissonian pedicle. Method: The Glissonian approach with hanging-over method is well known method for open liver resection. And, it could be applied for laparoscopic liver resection for experienced HBP surgeons. The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal triad.. This Glissonian sheath encloses the portal trinity. We describe the technique for laparoascopic approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approch that allows early delineation of the liver segment without the need for ancillary techniques. Pedicle to Rt. Lobe and Lt. Lobe could be separated first. Then, pedicle to Rt. Anterior and Posterior segement could be isolated as whole Glissonian pedicle by laparoscopic approach. Result: Especially rt. Posterior segment have large surface for surgical resection and difficulty for mobilization of Rt. Lobe. After passing the silicon tube through RPS Glissonian pedicle and with/without Rt. Hepatic vein, hanging over for Rt. Posterior parenchyma could be achived. Conclusion: Moreover, laparoacopic Glissonian approach with modified hanging over maneuver could help the laparoscopic major liver section. Future prospectively, the usefulness of this technique for oncologic aspect and surgical result are also discussed.
Laparoscopic Bile Duct Exploration with Glissonian Approach and Individual Dissection
( Sam-youl Yoon ),( Hyung-jun Han ),( Jin-suk Lee ),( Tae-jin Song ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Purpose: Laparoscopic Glossonian approach is very useful method not only in open hepatectomy but also in laparoscopic hepatectomy. Laparoscopic Glissonian approach followed by individual dissection makes it easy and safe for individualization of portal triad. Moreover, in the case of impacted bile duct stone in the hilar area, it makes easy bile duct exploration without blood loss. Method: Laparoscopic Glissonian approach and extracorporeal control of Glissonian pedicle make it easy and safe dissection of parenchyma and pedicle control. Hepatectomy including bile duct exploration by using combination of Glissonian approach followed by individual dissection could help bile duct exploration easy without bleeding. If IHD stone was located in the main bifurcation, bile duct exploration should be required. Glissonian approach made identification of left pedicle more easy. After isolation of left pedicle, individual dissection of hepatic artery and left portal vein was easy and safe. After dissection of liver parenchyma using Glissonian approach, bile duct exploration with ligation of left hepatic artery and portal vein performed. Result: This combination method has the advantages of Glissonian approach such as, short operation time and easy approach of hilum. Moreover, it makes bloodless and safe bile duct exploration in hilar type IHD stone. Conclusion: Combination of Glissonian approach and individual dissection is useful method in laparoscopic liver resection requiring bile duct exploration. We report the case of a 59-year-old female patient with Left IHD stone located from bifurcation to peripheral area in the left hepatic lobe. Laparoscopic left hepatectomy without bile duct exploration could result in remnant stone in bifurcation sometimes. Left hepatectomy including bile duct exploration by using combination of Glissonian approach and individual dissection could help bile duct exploration easy without bleeding. If IHD stone was located in the main bifurcation, bile duct exploration should be required. Glissonian approach made identification of left pedicle more easy. After isolation of left pedicle, individual dissection of left hepatic artery and left portal vein was easy and safe. After dissection of liver parenchyma using Glissonian approach, bile duct exploration with ligation of left hepatic artery and portal vein performed. The advantage of combination method is easy and safe hepatectomy and bile duct exploration could be achieved.