Isolation of right main and sectional portal pedicles for liver resection without hepatotomy or inflow occlusion [Letter to the Editor]
Machado MA , Martins AC and Machado MC
J Am Coll Surg 2008; 207(5):787-789



PDF (72 KB)

We read with great interest the article by Strasberg and colleagues in the “Surgeon at Work” section of the February 2008 Journal of the American College of Surgeons issue, titled, “Isolation of right main and sectional portal pedicles for liver resection without hepatotomy or inflow occlusion.” Our interest in reading the technique description and its results in this article relates to the fact that we had the opportunity to propose and publish a similar approach to the Glissonian sheath 5 years ago in Archives of Surgery. Another use for this approach is during bisegmentectomy 5-8 as published in 2005, during mesohepatectomy, and for left trisectionectomies. Application of our technique was also feasible in cirrhotic livers and our preliminary results were published in 2006. The description of techniques of right liver resections is of utmost importance because they represent a significant technical advance in performing anatomic resection of right liver sections or segments. The knowledge and use of Glissonian pedicles of liver segments is a logical approach in modern liver surgery. It precludes the tedious dissection of hilar structures, as we discussed in previous papers. Figure 1 in our previous article is an intraoperative photograph very similar to Figure 9 from their work. The chief purpose of the article published by Strasberg and colleagues,1 as stated by the authors in their introduction, was to review techniques used for sectional pedicle isolation. But their extensive review stopped at the year 2000. Indeed, from 2000 to the present, several reports have been published related to the same subject and some important ones published before 2000 should have been cited in their article. The whole concept and use of Glissonian sheaths access for liver resections can also be applied for laparoscopic hepatectomies. Nevertheless, we think that this is a very important technique that should be used worldwide.