Standardization of Laparoscopic Left Hemihepatectomy by Extrahepatic Glissonean Pedicle Isolation and HV Root - At First One-way Resection Based on Laennec’s Capsule

Laparoscopic left hemihepatectomy (LLH) is one of the major hepatectomy procedures and its surgical techniques are not well standardized. According to our surgical strategies for anatomic liver resections, which are composed of the extrahepatic Glissonean pedicle approach (GPA) and hepatic vein (HV) root-at first one-way parenchymal dissection, we have standardized the surgical techniques for LLH. Both approaches are based on the anatomical background of Laennec’s capsule. The right and left sides of the root of the Glissonean pedicle including the umbilical portion of the portal vein (G-UP) are dissected with Laennec’s capsule preserved on the liver parenchyma. The G-UP is isolated extrahepatically and divided using a stapler. The common trunk of the left hepatic vein (LHV) and middle hepatic vein (MHV) is exposed from the left cranio-dorsal side and LHV is divided at its root. Parenchymal dissection starts from exposing the root of MHV, which is tracked from the root side to the peripheral side in one direction. Left hemihepatectomy is completed at the left side of the gall bladder bed. In conclusion, LLH can be standardized by initial isolation and division of G-UP according to the Laennec’s capsule-based extrahepatic GPA followed by HV root-at first cranio-caudal, one-way parenchymal resection.