Hepatic trisectionectomy for hepatocellular carcinoma using the Glisson pedicle method combined with anterior approach.

Abstract

Hepatic trisectionectomy is a challenge for surgeons. We describe a technique by combination of the Glisson pedicle method and anterior approach to perform hepatic trisectionectomy. In this technique, the Glisson pedicles are isolated above the hilar plate without hilar dissection. After dividing these pedicles, the hepatic hilum can be lowered more easily. With the hepatic hilum brought down, the following step of hepatic parenchyma transection using the anterior approach can be performed safely, avoiding accidental injury to the vessels and hepatic duct in the hilar plate. This technique provides a safe, easy way to perform hepatic trisectionectomy without warm ischemia injury to the remnant liver.