Dorsal approach with Glissonian approach in laparoscopic anatomic hepatectomy for right lobe

Abstract Background: Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. We previously reported that Glissonian approach combined with major hepatic vein first was effective for LAH. Because dorsal approach could effectively expose the major hepatic vein, we merged it with Glissonian approach in LAH for the right lobe.Methods: Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). First, the paracaval portion of caudate lobe along the IVC was transected through dorsal approch after the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed from its trunk to the root. Then, the liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected.Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05).Conclusions: Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, although it is essential to include more cases for further study.