Glissonean pedicle transection method for liver surgery (with video).

Area of Science:

• Hepatobiliary Surgery
• Surgical Anatomy
• Liver Cancer Treatment

Background:

• The Glissonean pedicles, comprising the hepatic artery, portal vein, and bile duct, are encased in Glisson's capsule.
• These pedicles can be accessed either inside (intrahepatically) or outside (extrahepatically) the liver.
• The extrahepatic approach at the hepatic hilus is also known as Couinaud's extra-fascial access.

Purpose of the Study:

• To introduce and explain the Glissonean pedicle approach for liver surgery.
• To highlight its advantages in anatomical liver resections.
• To emphasize its suitability for specific liver cancer cases, like hepatocellular carcinoma (HCC).

Main Methods:

• Ligating secondary Glissonean pedicles at the hepatic hilus without requiring extensive liver dissection.
• Utilizing an approach angle over the hilar plate to bypass variations in arteries or bile ducts.
• Accessing tertiary branches either intrahepatically or extrahepatically at section borders.

Main Results:

• The Glissonean pedicle approach enables simple, safe, and easy liver resection.
• This technique is particularly beneficial for liver cancer without hilar invasion, especially for hepatocellular carcinoma (HCC).
• It facilitates small anatomical hepatectomies like sectionectomy or segmentectomy, suitable for patients with liver dysfunction and HCC.

Conclusions:

• The Glissonean pedicle transection method advances liver surgery techniques and anatomical understanding.
• It provides a straightforward and secure method for liver resection, especially in HCC cases.
• Surgeons should understand this fundamental concept for performing anatomical hepatectomies effectively.