Methods A 62-year-old man with colorectal liver metastasis occupying central liver segments was referred for surgical treatment. The first step may be the charge of segment 4 pedicle. While using round ligament like a guide, one incision is performed on its right margin and the other is created at the end of segment 4. A vascular clamp is introduced through those incisions to occlude segment 4 Glissonian sheath. The next step is to manage the right anterior pedicle. The first incision is made while watching hilum and another is conducted about the right edge of gallbladder bed. Laparoscopic clamp is introduced through these incisions and closed producing ischemic discoloration of segments 5 and 8. Vascular clamp is replaced by an endoscopic vascular stapling tool and stapler is fired. Type of liver transection is marked along the liver surface following ischemic area.

Liver transection is accomplished with bipolar vessel sealing device and endoscopic stapling device as appropriate. Specimen was extracted via a suprapubic incision. Liver raw surfaces were reviewed for bleeding and bile leaks. Results Operative time was 200 min with minimum blood loss with no need for blood transfusion. Recovery was uneventful, and the patient was discharged about the fifth postoperative day. Histological examination revealed clear surgical margins. Conclusions Mesohepatectomy could be safely performed laparoscopically in selected patients and by surgeons with expertise both in liver surgery and laparoscopic techniques. The use of the intrahepatic Glissonian approach may help to identify the exact limits of the mesohepatectomy to prevent ischemic injury of the remnant liver.

Liver surgery is a complex surgical specialty that requires extensive knowledge of liver anatomy and surgical techniques. In recent years, laparoscopic liver surgery has become increasingly popular, offering patients a minimally invasive surgical approach with reduced pain, scarring, and recovery time. One of the most complex liver surgeries is a right trisectionectomy, which involves removing the right side of the liver. In this essay, we will discuss the use of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach, its advantages, and the challenges associated with this surgical approach.

Background

Laparoscopic liver surgery was first introduced in the 1990s as a modification of traditional open liver surgery. Laparoscopic liver surgery uses a laparoscope, a thin tube with a camera on the end, to guide surgical instruments through small incisions in the abdomen. While laparoscopic liver surgery offers many advantages over traditional open surgery, such as less pain and scarring, it also has some disadvantages, including a limited field of vision and the difficulty of manipulating surgical instruments within the liver.

The right trisectionectomy is one of the most complex liver surgeries and requires extensive surgical skill and experience. In a right trisectionectomy, the right side of the liver is removed, including the right hepatic vein, right portal vein, and right bile duct. The remaining liver is then connected to the remaining hepatic vein, portal vein, and bile ducts.

Totally Laparoscopic Right Trisectionectomy Using Intrahepatic Glissonian Approach

One of the latest advancements in laparoscopic liver surgery is the use of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach. In this approach, the liver is divided into four sectors, each of which is supplied by a branch of the hepatic artery, portal vein, and bile duct. The Glissonian approach involves identifying and dividing these branches, which allows for precise control of the hepatic inflow and outflow.

Advantages of Totally Laparoscopic Right Trisectionectomy Using Intrahepatic Glissonian Approach

One of the main advantages of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach is the minimally invasive nature of the surgery. Unlike traditional open liver surgery, which requires large incisions, laparoscopic liver surgery only requires small incisions. This results in less pain, scarring, and blood loss. Additionally, the smaller incisions often result in a shorter recovery time and a shorter hospital stay.

Another advantage of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach is the ability to perform precise dissection and control of the hepatic inflow and outflow. This can be particularly important in complex liver surgeries such as right trisectionectomy, where precise tissue dissection is critical.

Challenges of Totally Laparoscopic Right Trisectionectomy Using Intrahepatic Glissonian Approach

One of the main challenges of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach is the complexity of the surgery. Right trisectionectomy is one of the most complex liver surgeries and requires extensive surgical skill and experience. Additionally, the laparoscopic approach requires specialized training and experience, and it can take time for surgeons to become proficient in its use.

Another challenge of totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach is the risk of bleeding and injury to surrounding organs. The liver is a highly vascular organ, and controlling bleeding can be a challenge in laparoscopic liver surgery. Additionally, the laparoscopic approach requires the use of specialized surgical instruments that can be difficult tomanipulate within the liver, increasing the risk of injury to surrounding organs.

Finally, there is a risk of conversion to traditional open surgery in the event of technical difficulties or complications. While laparoscopic liver surgery has many advantages over traditional open surgery, it is not always feasible or safe to perform laparoscopically. In some cases, conversion to traditional open surgery may be necessary to ensure a successful surgery.

Conclusion

Totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach is a complex and challenging surgical procedure that requires extensive surgical skill and experience. While it offers many advantages over traditional open surgery, such as reduced pain, scarring, and recovery time, it also has several challenges, including the complexity of the surgery, the risk of bleeding and injury to surrounding organs, and the risk of conversion to traditional open surgery.

Ultimately, the decision to undergo totally laparoscopic right trisectionectomy using intrahepatic Glissonian approach should be made on a case-by-case basis, taking into account the patient's medical history, the complexity of the procedure, and the risks and benefits of each surgical approach. It is important for patients to discuss their options with their healthcare provider and to be aware of the potential risks and benefits of laparoscopic liver surgery.

As laparoscopic liver surgery continues to advance, it is likely that more complex liver surgeries such as right trisectionectomy will be performed using laparoscopic techniques. However, it is important for surgeons to continue to refine their techniques and develop new approaches to ensure safe and successful laparoscopic liver surgeries.