Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach.
Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach.
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DOI：
10.4174/astr.2017.92.5.383
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发表时间：
2017-05
影响因子：
1.4
通讯作者：
Joh JW
中科院分区：
文献类型：
--
作者：
Lee N;Cho CW;Kim JM;Choi GS;Kwon CHD;Joh JW
Glissson入路因其操作简单而被广泛应用于开胸肝切除术。但由于活动受限，在全腹腔镜术中的设置并不容易。在此，我们提出了一种新的、简单的半肝切除方法，称为Glisson蒂的临时流入控制(TICGL)技术。从肝实质分离Glisson椎弓根，直到可见椎弓根的后缘，并用斗牛犬夹子夹住。没有必要环绕椎弓根。肝实质切除是在切除侧肝脏的流入控制下进行的，出血较少。在完成充分的切除以显示整个Glisson椎弓根结构后，椎弓根被环绕，通常非常容易，而不必担心从椎弓根后侧出血，这是在实质切除前进行环扎时的常见问题。然后可以安全地使用吻合器，而不会损伤主要的肝静脉，因为它们已经暴露。装订是在胶带向对侧缩回的同时完成的。这种回缩可以防止对侧Glisson型椎弓根分支的损伤或狭窄。切除残留的肝实质，完成肝切除术。TICGL技术提供了一种安全、简便的方法，不仅可以由专业的腹腔镜外科医生进行，也可以由经验较少的外科医生进行。因此，它可以成为行半肝切除的一种标准方法。
The Glissonian approach, due to its simplicity of procedure, is a technical procedure widely used in open hepatectomy. However, it is not easily applicable in the setting of the total laparoscopic approach because of movement restriction. We herein propose a new and simple method of performing hemihepatectomy by Glissonian approach called temporary inflow control of the Glissonian pedicle (TICGL) technique. Dissection of the Glisson pedicle from the liver parenchyma is done until the posterior margin of the pedicle is visualized, and is clamped with bulldog clamps. Encircling the pedicle is not necessary. Resection of the liver parenchyma is performed under inflow control of the resected side liver providing less bleeding. After sufficient resection is done so that the whole Glissonian pedicle structures are visualized, the pedicle is encircled, often very easily without the fear of bleeding from the posterior side of the pedicle, which is a common problem when encircling is done before parenchymal resection. The staplers may then be applied safely without injuring the major hepatic veins since they have been already exposed. Stapling is done while the tape is retracted toward the contralateral side. This retraction prevents injury or stricture of the contralateral Glissonian pedicle branch. The remnant liver parenchyma is resected and hepatectomy finalized. The TICGL technique provides a safe and easy way of performing major hemihepatectomies, not only by expert laparoscopic surgeons but by less experienced surgeons. It can therefore become a standard method of performing hemihepatectomy by Glissonian approach.