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Laparoscopic Anatomic Spiegel Lobectomy With the Extrahepatic Glissonean Approach

Xiang, Shuai MD, PhD; Zhang, Yu-xin MD; Chai, Song-shan MD; Zhang, Wan-guang MD, PhD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p e57–e59
doi: 10.1097/SLE.0000000000000654
Online Articles: Technical Reports

Background: Laparoscopic Spiegel lobectomy is difficult due to its deep location and being surrounded by gross vessels. Extrahepatic Glissonean pedicle transection method has been proposed by Takasaki during open liver resections. This approach can be successfully performed during laparoscopic anatomic hepatectomy. Here we describe pure laparoscopic Spiegel lobectomy using the extrahepatic Glissonean approach.

Methods: The patient was a 25-year-old male with a background of hepatitis B. A 1.5 cm×1.7 cm mass was detected in liver Spiegel lobe and highly suspected to be an hepatocellular carcinoma. The liver function was normal (Child-pugh 5), and alpha-fetoprotein was within the normal ranges. Laparoscopic Spiegel lobectomy using extrahepatic Glissonean approach was proposed. The hilar plate was partly detached from liver parenchyma, and 2 Glissonean pedicles of the Spiegel lobe were dissected, clamped and divided. Liver parenchymal transection was performed using the harmonic scalpel.

Results: The operation time was 196 minutes without Pringle’s maneuver. Estimated blood loss was <50 mL, and no blood transfusion was required. The patient recovered well and was discharged on postoperative day 6. There was no complication. Pathologic findings support the diagnosis of hepatocellular carcinoma.

Conclusions: Laparoscopic Spiegel lobectomy using the extrahepatic Glissonean approach is safe and feasible.

Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

We performed laparoscopic anatomic Spiegel lobectomy with the extrahepatic Glissonean approach on this patient (see the video, Supplement Digital Content 1, which showed this approach).

The author declares no conflicts of interest.

Reprints: Wan-guang Zhang, MD, PhD, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, Hubei province 430030, China (e-mail:

Received January 21, 2019

Accepted January 30, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.