Anatomical basis for the intrahepatic glissonian approach during hepatectomies

Abstract

BackgroundAnatomical liver resections are based on some basic technical principles such as vascular control, ischemic area delineation to be resected and maximum parenchymal preservation. These aspects are achieved by the intrahepatic glissonian approach, which consists in accessing the pedicles of hepatic segments within the hepatic parenchyma. Small incisions on well-defined anatomical landmarks are performed to approach the pedicles, making dissection of the hilar plate unnecessary.AimAnalyze parameters in liver anatomy related to intrahepatic surgical technique to glissonians pedicles, to set the normal anatomy related to the procedure and thereby facilitate the attainment of this technique.MethodsAnatomical parameters related to the intrahepatic glissonian approach were studied in 37 cadavers. Measurements were performed with precision instruments. Data were expressed as mean±standard deviation. The subjects were divided into groups according to gender and liver weight and groups were compared statistically.ResultsTwenty-five cadavers were male and 12 female. No statistically significant difference was observed in virtually all parameters when groups were compared. This demonstrates the consistency of the anatomical parameters related to the intrahepatic glissonian approach.ConclusionThe results obtained in this study made possible major technical advances in the realization of open and laparoscopic hepatectomies with intrahepatic glissonian approach, and can help surgeons to perform liver resections by this method.

The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: Results of an observational study over 7 years

“…No substantial difference was observed in these and other parameters in a recently published anatomic study. 23 In some situations, when segmental demarcation is not convincing, repeat clamping may be attempted until the desired demarcation is achieved. Bleeding from these incisions is minimal, and inflow is stopped after stapling the pedicles.…”

A Lesser-Known Hepatic Anatomical and Surgical Structure: the Rouviere-Gans Incisura (RGI)

“…Although the presence of RGI is found between 52%-82% of cases (3)(4)(5)(6)(7)13,14), in a series of classical or surgical anatomy tratises, this is not even mentioned! (15)(16)(17).…”

“…3). In almost half of cases, a GP for Sg6 detaches itself from the anterior edge of the PSGP, and GP detaches for the CPr or for Sg7 (5,14). In practice, dissection in the initial or middle portion of the RGI can highlight, quite frequently (30%-50% of cases), a GP of Sg6instead of PSGP -as a result of a GP of Sg6 detachment from the very origin of PSGP (22,23), or through an early division of this sectional GP, into GP of Sg6 and GP of Sg7.…”

Pediatric Liver Transplantation With Ex-Situ Liver Transection and the Application of the Human Fibrinogen and Thrombin Sponge in the Wound Area

“…Hepatic reduction, described by Bismuth et al in 1984 4 , a non ruler hepatectomy is performed in the hepatic graft (where the hepatic resection line does not preserve the hepatic anatomical segments 33 ) during the preparation of the organ at the auxiliary table, in order to reduce the size of the graft to fit the size of the recipient.…”

“…The split technique was described by Pichlmayr in 1988 27 , in which, from a cadaveric donor the liver graft is divided, into an auxiliary table, respecting the anatomic liver segments 33 and preserving the vascular structures, obtaining two partial grafts able to transplant for two different recipients (Figure 1). A graft composed of segments II and III (used in a pediatric receptor) and another by segments I, IV-VIII (used in an adult recipient).…”