Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule: proposal of a novel comprehensive surgical anatomy of the liver

Sugioka, Atsushi; Kato, Yutaro; Tanahashi, Yoshikatsu

doi:10.1002/jhbp.410

Cited by 143 publications

(172 citation statements)

References 6 publications

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“…Furthermore, Sugioka recently reported that Glisson's capsule and Laennec's capsule can be divided outside and inside the liver. Therefore, the Glissonean pedicles can be separated from Laennec's capsule and not only the main portal pedicles but also the sectional and segmental pedicles can be approached at the hepatic hilus without liver dissection . This concept supports Takasaki's procedure.…”

Section: The Extrafascial Approachmentioning

confidence: 76%

Glissonean pedicle approach in liver surgery

Yamamoto

Ariizumi

2018

Annals of Gastroent Surgery

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Glisson's capsule was discovered by Johannis Walaeus in 1640 and described by Francis Glisson in 1654. The capsule wraps the hepatic artery, the portal vein and the bile duct in the liver and forms bundles at the hepatic hilus and in the liver as the Glissonean pedicle tree. Glisson's capsule does not connect to the proper membrane of the liver, which was discovered by Laennec; therefore, the Glissonean pedicles can be detached from the liver parenchyma without liver dissection. Couinaud described three main approaches to control the inflow system at the hepatic hilus in liver surgery; the intrafascial approach, the extrafascial and transfissural approach, and the extrafascial approach. The intrafascial approach is the so‐called control method. The extrafascial and transfissural approach, and the extrafascial approach are recognized as the Glissonean pedicle approach. When the Glissonean pedicles are ligated before liver transection, various types of anatomical hepatectomy can be carried out. The Glissonean pedicle approach is, therefore, considered to be one of the most important procedures in liver surgery. We herein describe the historical aspects and procedures of the Glissonean pedicle approach in liver surgery.

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Section: The Extrafascial Approachmentioning

confidence: 76%

Glissonean pedicle approach in liver surgery

Yamamoto

Ariizumi

2018

Annals of Gastroent Surgery

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“…There is a relatively dense connective tissue on the liver side and sparse connective tissue on the diaphragm side of the fused peritoneal peritoneum. The structure composed of dense connective tissue on the liver side and liver serosa is the Laennec's capsule [12,13]. Because the liver surface of the bare area is covered with the Laennec's capsule, as shown in our study, the phrase "bare area" may not be appropriate.…”

Section: Discussionmentioning

confidence: 82%

Structure and surgical dissection layers of the bare area of the liver

et al. 2020

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Background: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. Methods: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. Results: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. Conclusions: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.

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“…In our method, however, the RHV trunk can be isolated with a thick wall by attaching the fibrous tissue around it. This tissue ("Laennec's capsule") essentially covers the liver parenchyma (5) Brief report | 5 can be intentionally preserved on the RHV wall by exposing it from the root side (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%