Mamoru Morimoto1, Federico Tomassini2, Giammauro Berardi3, Yasuhisa Mori4, Chikara Shirata5, Mohammed Abu Hilal6, Horacio J Asbun7, Daniel Cherqui8, Naoto Gotohda9, Ho-Seong Han10, Yutaro Kato11, Fernando Rotellar12, Atsushi Sugioka11, Masakazu Yamamoto13, Go Wakabayashi14. 1. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan. 2. Department of Oncological and Emergency Surgery, Policlinico Casilino, Rome, Italy. 3. Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini hospital of Rome, Rome, Italy. 4. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 6. Department of Surgery, Instituto Fondazione Poliambulanza, Brescia, Italy. 7. Hepato-Biliary and Pancreas Surgery - Miami Cancer Institute, Miami, FL, USA. 8. Hepatobiliary Center, Paul Brousse Hospital, Paris, France. 9. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan. 10. Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. 11. Department of Surgery, Fujita Health University, Aichi, Japan. 12. HPB and Liver Transplant Unit, Clínica Universidad de Navarra, Pamplona, Spain. 13. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 14. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan.
Abstract
BACKGROUND: The Glissonean approach has been widely validated for both open and minimally invasive anatomic liver resection (MIALR). However, the possible advantages compared to the conventional hilar approach are still under debate. The aim of this systematic review was to evaluate the application of the Glissonean approach in MIALR. METHODS: A systematic review of the literature was conducted on PubMed and Ichushi databases. Articles written in English or Japanese were included. From 2,390 English manuscripts evaluated by title and abstract, 43 were included. Additionally, 23 out of 463 Japanese manuscripts were selected. Duplicates were removed, including the most recent manuscript. RESULTS: The Glissonean approach is reported for both major and minor MIALR. The 1st, 2nd and 3rd order divisions of both right and left portal pedicles can be reached following defined anatomical landmarks. Compared to the conventional hilar approach, the Glissonean approach is associated with shorter operative time, lower blood loss, and better peri-operative outcomes. CONCLUSIONS: Glissonean approach is safe and feasible for MIALR with several reported advantages compared to the conventional hilar approach. Clear knowledge of Laennec's capsule anatomy is necessary and serves as a guide for the dissection. However, the best surgical approach to be performed depends on surgeon experience and patients' characteristics. Standardization of the Glissonean approach for MIALR is important.
BACKGROUND: The Glissonean approach has been widely validated for both open and minimally invasive anatomic liver resection (MIALR). However, the possible advantages compared to the conventional hilar approach are still under debate. The aim of this systematic review was to evaluate the application of the Glissonean approach in MIALR. METHODS: A systematic review of the literature was conducted on PubMed and Ichushi databases. Articles written in English or Japanese were included. From 2,390 English manuscripts evaluated by title and abstract, 43 were included. Additionally, 23 out of 463 Japanese manuscripts were selected. Duplicates were removed, including the most recent manuscript. RESULTS: The Glissonean approach is reported for both major and minor MIALR. The 1st, 2nd and 3rd order divisions of both right and left portal pedicles can be reached following defined anatomical landmarks. Compared to the conventional hilar approach, the Glissonean approach is associated with shorter operative time, lower blood loss, and better peri-operative outcomes. CONCLUSIONS: Glissonean approach is safe and feasible for MIALR with several reported advantages compared to the conventional hilar approach. Clear knowledge of Laennec's capsule anatomy is necessary and serves as a guide for the dissection. However, the best surgical approach to be performed depends on surgeon experience and patients' characteristics. Standardization of the Glissonean approach for MIALR is important.