Authors
Jimin Son, Ji Hoon Kim
Published in
Annals of surgical oncology. Oct 24, 2026. Epub Oct 24, 2026.
Abstract
Laparoscopic extended right posterior sectionectomy (eRPS), including the dorsal segment of the right anterior section (RAS), is a technically demanding but parenchyma-preserving alternative to right hepatectomy. Its success depends on accurate identification of the anatomically variable intersegmental plane. This study describes a tailored Glissonean approach according to the presence or absence of the anterior fissure vein (AFV).
Between December 2020 and July 2023, six consecutive patients underwent laparoscopic eRPS including the dorsal RAS. Preoperative three-dimensional (3D) reconstruction was used to evaluate the right anterior Glissonean pedicle (RAG) branching pattern and presence of a definite AFV. When an AFV was identified, an AFV-guided transfissural approach was used; when absent, an intrahepatic Glissonean approach using the RAG as an intraparenchymal landmark was performed. Indocyanine green (ICG) fluorescence confirmed the ischemic boundary after target pedicle ligation.
Median operative duration was 260 min and median blood loss was 175 mL, with no transfusions. A definite AFV was identified in five of six patients (83.3%). Median tumor size was 31 mm (range 15-52 mm), and all cases achieved R0 resection. Median hospital stay was 6.5 days (range 5-21 days). One patient (16.7%) experienced postoperative ileus, with no perioperative mortality.
A tailored Glissonean approach guided by preoperative 3D reconstruction and complemented by ICG fluorescence provides a practical framework for laparoscopic eRPS. Careful case selection remains essential.
PMID:
42926304
Bibliographic data and abstract were imported from PubMed on 25 Oct 2026.
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