In reply We want to thank Prof Batignani for his letter describing his personal experience with the left glissonian pedicles approach. As stressed by his letter, our technique for isolation of the left hepatic pedicle is always reliable and complete. We agree that sometimes the pedicles for each left liver segment may be located deep in the hepatic parenchyma. If one tries to dissect too far from the emergence of these pedicles, they may be faced with secondary branches resulting in incomplete ischemia of the corresponding left liver segment. This information is very important for readers. However, when faced with this problem, we encircled the main left portal pedicle and pulled it downward. This simple maneuver enhances the identification and further clamping of all left liver segmental glissonian sheaths, even the deepest ones. Correspondence: Dr Marcel Autran C. Machado, Al Casa Branca 438, 101-01408-000, São Paulo, Brazil (firstname.lastname@example.org).
Archives of Surgery – American Medical Association
Published: Aug 1, 2005
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