Intrahepatic Glissonian approach for pedicle control during anatomic
Machado MA, Herman P, Machado MC
Surgery 2007; 141(4):533-7.



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Centrally located liver tumors can be removed by either right or left trisectionectomies. These procedures are technically demanding and remove 60% to 85% of the liver parenchyma, much of which may not be involved with the neoplasm, and are often associated with severe complications, including hepatic failure. To reduce the risk of liver failure after extended liver resection, it is possible to perform preoperative portal embolization to obtain hypertrophy of the future remnant liver. Another option is to minimize the volume of normal liver resected by removing only the central hepatic segments (Couinaud's segments 4, 5, and 8). This technique, called central hepatic resection or mesohepatectomy, was first described in 1972 by McBride and Wallace. Mesohepatectomy, however, has not gained the popularity of extended hepatectomy probably due to the complexity of the procedure. The development of segment-based resection using intrahepatic Glissonian access made it possible to develop techniques to identify and isolate the right and left segmental Glissonian pedicles. These techniques allow complete ischemic demarcation of the central liver segments that facilitate anatomic mesohepatectomies with sufficient residual liver.In this study, the authors report the results of their own technique of mesohepatectomy based on an intrahepatic Glissonian approach described previously.