Glissonean Pedicles Approach in Minimally Invasive Liver Surgery

This kind of technique for hepatectomy has been gaining interest in recent years and may represent the ideal method to achieve anatomical liver resections.

Currently the most performed procedure for liver surgery is still the classic intrafascial approach in which, after entering the Glissonean sheath, the portal triad elements are singularly dissected and isolated. However, this is a quite challenging technique to pursue in a minimally invasive setting.

Nowadays the laparoscopic and robotic approach for liver resections are increasing worldwide and the intra or extra hepatic Glissonean approach, in which the portal triad elements are dissected and isolated “en bloc” without entering the Glissonean sheath, can facilitate the surgical technique. Furthermore this strategy allows better identification of the ischemic area and could decrease bloodloss during dissection, as the liver inflow is kept under control.