fig3

Figure 3. Extrahepatic Glissonian approach for anatomic (sub)segmentectomy using the subtraction method. (A) Extrahepatic isolation of Glissonian pedicles to Sg8 (G8), anterior Sg5 (G5a) and Sg8 (G8a) subsegments and anterior section (G-ant) during open anatomic subsegmentectomy 8a. Laennec’s capsule on the gall bladder (GB) bed and the cystic plate (area inside the dotted line) resected along with GB are shown; (B) extrahepatic isolation of Glissonian pedicles to Sg6 (G6), Sg7 (G7), anterior (G-ant) and posterior (G-post) sections and right hemiliver (G-right) during laparoscopic anatomic segmentectomy 7; (C) extrahepatic isolation of Glissonian pedicles to lateral (G8b) and dorsal (G8c) subsegments of Sg8, their root (G8bc) and G-ant during robotic anatomic subsegmentectomy Sg8b; (D) [same case with (C)] Isolated Sg8b ischemia shown using “negative staining technique” in the Firefly mode after systemic infusion of ICG during selective clamping of G8b.