Exploring the Fine-Layer Structure Around a Glissonean Pedicle in Cadaveric Models

Abstract

Background: Glissonean pedicle isolation is a very useful procedure during a laparoscopic anatomic hepatectomy (LAH); however, few studies have reported the precise layer structure around a Glissonean pedicle. The aim of this study was to evaluate the layer structure around a Glissonean pedicle in cadaveric models and determine whether Glissonean pedicle isolation based on the layer structure can serve as a standard surgical procedure during a LAH. Methods: From April 2017 to December 2019, LAHs were performed in 59 patients. Prior to the LAH, a cadaveric model was used to verify the layer structure around the Glissonean pedicle. The procedure was also performed in live patients during LAHs and pathologic verification was performed. In addition, we evaluated the short-term results of LAHs. Results: Laennec's capsule covering the liver parenchyma was shown by histologic examination (Elastica van Gieson staining) in a cadaveric model and live patients. The gap between the Glissonean pedicle and Laennec's capsule was dissected without parenchymal destruction. A LAH based on cadaver simulation had an operative time of 398 min and blood loss of 142 ml. Post-operative complications occurred in 2 patients (3%), and there were no mortalities. The length of hospital stay was 13 days. Conclusion: There is a layer structure around the Glissonean pedicle; it is necessary to recognize Laennec's capsule as a landmark. When performing Glissonean pedicle isolation, it is possible to perform a safer and more precise LAH by placing importance on Laennec's capsule.

Porta-caval fibrous connections — the lesser-known structure of intrahepatic connective-tissue framework: A unified view of liver extracellular matrix

“…In the hepatic hilus, the liver capsule directly touches the hilar plate (also known as Walaeus vascular-biliary sheath) covering the portal vein, the hepatic artery, and the bile ducts, while within the liver, the intrahepatic part of the liver capsule — PHC — covering the parenchyma, sets against the perivascular fibrous capsule (Glisson’s capsule), which is a direct extension of the Walaeus sheath and envelops the lobar, sectoral, and segmental portal tracts[ 15 , 22 ]. These two fibrous fascial structures — PHC and Glisson’s capsule — are separated by a narrow fissure[ 10 ] (Figure 1A and C ). The individual fibers of the connective tissue (or their bundles) are located in this fissure and connect the outer side of Gleason’s capsule with the PHC.…”