Intrahepatic Glissonian approach for anatomical resection
of left liver segments

Machado MA et al

Langenbecks Arch Surg (2008) 393:1017
DOI 10.1007/s00423-008-0389-0



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We read with great interest the article by Chen and Qiu [1]:
in the “How I Do It” Langenbeck’s Archives of Surgery
2008;393:227–230 entitled “A simple technique ligating
the corresponding inflow and outflow vessels during
anatomical left hepatectomy.”
Our interest in reading the technique description and its
results in the paper now published by Chen and Qiu relates
to the fact that we had the opportunity to propose and
publish this very same modality of approach to the
Glissonian sheath 4 years ago in Archives of Surgery [2].
Another use for this approach is during anatomical left
trisectionectomies as published in 2005 [3]. The application
of our technique was also feasible in cirrhotic livers and our
preliminary results were published in 2006 [4].
The description of techniques of left liver resections is of
utmost importance as they represent a significant technical
advance in performing anatomical resection of left liver
segments. The knowledge and use of Glissonian pedicles of
liver segments is a logical approach in modern liver surgery
[2]. It precludes the tedious dissection of hilar structures as
we already discussed in previous papers [2–8].
Chen and Qiu’s technique is very similar with ours;
however, they stress the outflow control of the correspondent
hepatic veins (left hepatic vein or common trunk). We also
think that outflow control is very important and we cited in our
article a technique described elsewhere [9–10]. The Fig. 2 that
appeared in our article [2] is an intraoperative photograph
identical to the drawing present in their paper (as Fig. 1).
Similar figures also appeared in other papers [3, 4].
Although the authors stated that they have been using
this technique for the last 18 years, this approach has never
been published before and therefore we believe that the
author should have mentioned our technique in their paper
since our technique has been published in impact medical
journals. Nevertheless, we still think that this is a very
important technique and should be used worldwide.