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Published on: October 6, 2023
Ramification of Glisson's sheath peripheral branches and clinical implications in the era of local ablation therapy
Jung Hun Lee1, Guang Yu Jin, Zhe Wu Jin
1Department of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, Republic of Korea.
Purpose:
Classical anatomical resection does not always guarantee tumor-free margins when the tumor overrides traditional anatomical planes. Surgeons and interventionists frequently need to focus on the peripheral branches of Glisson's sheath in patients with poor hepatic reserves, particularly when the tumor is deep seated. The present study used anatomical liver dissection to investigate the spatial distribution of the branches of Glisson's sheath in each of four liver sectors.
Methods:
Sixty-four adult human liver specimens were dissected. The size and ramification patterns of Glisson's sheath in each sector were analyzed in terms of bilateral homology within two paramedian sectors and within two lateral sectors.
Results:
Each liver sector had a characteristic Glisson's sheath in terms of trunk shape and ramification pattern. The two paramedian sectors showed point symmetry. Most of the branches of the two paramedian sectors emerged from the top of a short stout trunk. Although the two paramedian sectors were similar in terms of basic configuration, the ramification axes were almost perpendicular to each other. Unlike the paramedian sectors, the two lateral sectors showed not much homology.
Conclusions:
The peripheral branches of Glisson's sheath were generally longer (approximately 5 cm) and thicker than anticipated. Extirpation strategies should take into account that each liver sector has a characteristic Glisson's sheath ramification pattern.
Insights
Liver anatomy is complex; Glisson's sheath branches vary by sector. Understanding these unique patterns is crucial for effective liver tumor resection and achieving tumor-free margins.
Area of Science:
- Surgical anatomy
- Hepatic surgery
- Vascular anatomy
Background:
- Achieving tumor-free margins in liver resections can be challenging, especially with deep-seated tumors or compromised hepatic reserves.
- Traditional anatomical resections may not account for variations in Glisson's sheath branching, impacting surgical outcomes.
Purpose of the Study:
- To investigate the spatial distribution and ramification patterns of Glisson's sheath branches within each of the four liver sectors.
- To provide anatomical data relevant to surgical planning for liver resections.
Main Methods:
- Anatomical liver dissection of 64 adult human liver specimens.
- Analysis of Glisson's sheath size and ramification patterns in each sector.
- Comparison of patterns for bilateral homology within paramedian and lateral sectors.
Main Results:
- Each liver sector exhibits a distinct Glisson's sheath trunk shape and ramification pattern.
- Paramedian sectors display point symmetry with branches emerging from a short, stout trunk, though ramification axes differ.
- Lateral sectors show less homology compared to paramedian sectors.
Conclusions:
- Peripheral Glisson's sheath branches are often longer and thicker than typically assumed.
- Surgical extirpation strategies must consider the characteristic, sector-specific Glisson's sheath ramification patterns for improved outcomes.
