Intrahepatic Glissonian approach for laparoscopic right trisectionectomy.

Liver resection is the definitive treatment for several benign and malignant liver diseases. Experience with laparoscopic procedures and recent advances in laparoscopic devices have created an evolving interest in the application of these techniques to liver resection. However, laparoscopic liver resections may be technically demanding. Pedicle control is an important step of liver resection. Anatomic hepatectomies usually require extensive hilar dissection. To facilitate pedicle control and reduce operating time, we have previously described a technique for laparoscopic right-liver resections by using the intrahepatic Glissonian approach. Laparoscopic right-liver trisectionectomy is a very complex procedure, and, to our knowledge, there is only one technical description, so far, in the English literature. This video demonstrates technical aspects of a totally laparoscopic right trisectionectomy, using the intrahepatic Glissonian approach. Our technique differs from that previously described by intrahepatic pedicle control and total control of venous outflow, which makes the procedure easier and safer for laparoscopy.