Intraglissonian approach to the round ligament for left lateral segmentectomy in a large hemangioma
Epublication WebSurg.com, May 2017;17(05). URL: http://websurg.com/doi/vd01en4963
In this video, we present the clinical case of a 65-year-old woman with a large hemangioma involving liver segments II and III. The patient consulted because of epigastric pain and dyspepsia. A laparoscopic approach was performed. Instead of using the conventional extraglissonian approach for left lateral segmentectomy, in this video, we described a new approach which consisted in dissecting and dividing the portal and arterial branches for segments II and III selectively. The CT-scan shows a large hemangioma occupying almost entirely the left lateral segments. Under general anesthesia, the laparoscopic approach was performed with 4 trocars. By selectively dividing the inflow for these left lateral segments (segments II and III), the parenchymal transection was performed safely, without bleeding, and the left suprahepatic vein could be transected with a stapler very easily. The extraction of the specimen was carried out increasing the incision for the 12mm trocar in the midline. The patient was discharged on postoperative day 4 without complications.