Laparoscopic Intra-Glissonian Left Lateral Segmentectomy for Hepatic Tumors, A Gold Standard Approach

Surgical resections are considered the standardized therapy for primary cancers of the liver and for the majority of the metastatic disease affecting this organ [1,2]. Outcome of hepatic resections is influenced primarily by massive bleeding during resection and the subsequent need for blood transfusion [3,4]. The standard technique to control intraoperative bleeding is The Pringle maneuver [5]; however it has the disadvantage of an ischemic-reperfusion injury. This could be particularly prominent in cirrhotic livers, which have little tolerance of anoxia and serum deprivation. Additionally, with this technique there are also associated risks of bacterial translocation, intrahepatic metastases, impaired liver regeneration, systemic inflammation, and multiple organ dysfunction syndromes [6]. This technique has been modified to decrease these adverse effects, with measures including intermittent (15 min or 30 min) occlusion [7], hemihepatic artery control (half-Pringle maneuver) [8,9], selective hepatic vascular exclusion for tumors involving the hepatic veins and ischemic preconditioning [10].