Pure laparoscopic living donor hepatectomy using the Glissonean pedicle approach (with video)

Background: The use of pure laparoscopic donor hepatectomy has been increasing, with various advantages reported. However, the Glissonean approach has not been adopted despite its usefulness. The aim of this study was to introduce the Glissonean pedicle approach for laparoscopic living donor hepatectomy. Methods: We retrospectively reviewed data from 11 patients who underwent pure laparoscopic donor hepatectomy for adult living donor liver transplantation. In this novel operative procedure, after mobilization of the liver, the right or left Glissonean pedicle was encircled, and then the liver parenchymal transection was completed. Next, the right or left hepatic artery, portal vein, and hepatic duct were dissected out. The right or left hepatic duct was divided under intraoperative cholangiography guidance using indocyanine green fluorescence, and the hepatic artery and the portal vein were cut. Finally, the hepatic vein was divided using the laparoscopic stapler, and the graft liver was procured via a suprapubic incision. Results: The overall median surgical time was 387 min (range 280–563 min), and the volume of blood loss was 75 mL (21–1228 mL). The warm ischemic time was 5 min (2–10 min). A conversion to open procedure was occurred in 1 patient. A complication, a grade IIIa bile leakage according to the Clavien–Dindo classification, was noted in 1 patient. Conclusion: This is the first report of the Glissonean pedicle approach for pure laparoscopic donor hepatectomy; our results demonstrate the safety and feasibility of this technique.