The application of the extraglissonian approach for selective hepatic inflow occlusion during laparoscopic anatomical segmentectomy

Objective

Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy, subsegmentectomy and multi-segmentectomy. The extraglissonian approach in the context of selective hepatic inflow occlusion has been skilled under laparoscopy. This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.

Methods

This retrospective study analyzed the clinical data of 114 patients diagnosed with hepatocellular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital between September 2020 and December 2022.

Results

The success rate of achieving the ischemic area using the described methods was determined to be 74.6%. Out of the 85 cases that underwent laparoscopic anatomical hepatectomy, 34 cases involved segmentectomy, 5 cases involved subsegmentectomy, and 46 cases involved multi-segmentectomy. The average duration of the operation, blood loss volume, and postoperative hospital stay were 229.0 ± 85.0 min, 133.0 ± 112.0 mL, and 5.4 ± 1.7 d, respectively. Notably, no intraoperative blood transfusions were necessary, and no postoperative complications were observed.

Conclusion

The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate, effectively guiding the selection process during laparoscopic parenchymal transection. Moreover, this technique has demonstrated safety, reproducibility, and significant potential for broader clinical adoption.