Background : The extrafscial approach (conventional Glissonean approach from the hilum) is an effective technique for anatomical liver resection. However, the tertiary portal pedicle may be difficult with this technique because of their anatomical variations and deep location. Herein, we present a technique of purely laparoscopic anatomical bi-segmentectomy for S5,6-located liver tumor using the transfissural Glissonean approach.

Methods : A 49-year-old female presented with a 4cm sized single mass in segment V,VI of the liver. (1) Dissection and clamping of the right main Glissonean pedicle, (2) Identification of the main portal fissure, (3) Parenchymal dissection along the main portal fissure (4) dissection and ligation of the segment V portal pedicles, (5) Dissection and ligation the segment VI pedicles after identification of posterior portal pedicle (6) transection of the ischemic demarcation line of the segment V,VI area.

Results : The operation time was 190 min, the estimated blood loss was 150 mL, and the The patient was discharged on postoperative day 7 without any complications.

Conclusions : The transfissural approach in tertiary portal pedicles is a feasible and effective technique for laparoscopic anatomical liver resection.