Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Anatomical Liver Resection

Background:

• Standard liver resections can be complex due to intricate vascular and biliary branching.
• Anatomical systematization of liver resection is crucial for oncological control and reducing complications.
• Glissonean code (G-code) branches offer a simpler anatomical landmark for surgical planning.

Purpose of the Study:

• To present a new method for hepatic resection utilizing Glissonean code (G-code) branches.
• To demonstrate the efficacy of a hilar approach for selective G-code branch management.
• To establish an anatomically systematized approach for liver cancer resection.

Main Methods:

• Development of a surgical technique involving the hilar approach to serve cancer-bearing G-code branches.
• Selective transection of G-code branches prior to liver parenchyma dissection.
• Application of the technique in 168 cases of hepatic resection for hepatocellular carcinoma.

Main Results:

• The new hilar approach for G-code branch management was successfully applied in the majority of cases.
• Only three out of 168 cases encountered difficulties in transecting certain third branches via the hilar approach.
• The method allows for anatomically systematized liver resections.

Conclusions:

• The developed hepatic resection method using a hilar approach for G-code branches is effective and safe.
• This technique facilitates anatomically systematized liver resections, particularly for hepatocellular carcinoma.
• The G-code based hilar approach simplifies the management of vascular and biliary structures during liver surgery.