Laparoscopic glissonean approach: Making complex something easy or making suitable the unsuitable?

Background: The use of laparoscopic glissonean approach has many potential benefits such as shorter operative
times, lower blood loss with low morbidity.
Methods: The aim with this study was to perform an evaluation of 12 years of our experience with laparoscopic
glissonean approach in liver surgery, from a technical standpoint using a prospective database. Anatomical
laparoscopic liver resections using hilar dissection and non-anatomical resections were excluded from this study.
Results: 327 patients (170 females and 157 males) with mean age of 56 years were included. 196 (60%) of
procedures were major resections. 65% of procedures were performed in the last 5 years. 208 patients were
operated on for secondary lesions. In 38 patients the liver was cirrhotic. Morbidity was 37.3% and 90-day
mortality occurred in 2 patients (0.6%). Blood transfusion was necessary in 10.7% of patients. Median hospital
stay was 4 days.
Conclusions: Laparoscopic glissonean approach is a safe and feasible technique. It may be preferred in some
clinical situations as it is associated with shorter operative times, lower blood loss, and low morbidity. It is
superior to standard laparoscopic hepatectomy when an anatomical resection, especially if a segment or section
is to be removed. However, application of this technique requires accurate preoperative tumor localization,
identification of potential anatomic pedicle variations, as well as surgeon expertise.