Glissonean pedicle transection method for liver surgery (with video)

The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. The Glissonean pedicles are wrapped by a connective tissue referred to as the Glisson’s capsule and include the hepatic artery, portal vein and bile duct. The Glissonean pedicles can be approached intrahepatically or extrahepatically. The extrahepatic approach at the hepatic hilus was referred to as the extra-fascial access by Couinaud. In summary, the secondary Glissonean pedicles are encircled and ligated at the hepatic hilus without liver dissection. The angle of approach should be over the hilar plate so that the surgeon does not have to consider any variations in the arteries or bile ducts. The tertiary branches can be approached through the hepatic hilus extrahepatically or intrahepatically on the border between the sections which are fed by the secondary Glissonean pedicles. This procedure is suitable for liver cancer without hilar invasion, particularly for hepatocellular carcinoma (HCC). Patients with HCC usually have liver dysfunction and HCC easily invades the peripheral portal vein; therefore, patients with HCC should only undergo small anatomical hepatectomies such as sectionectomy or segmentectomy. Any anatomical hepatectomy can be performed using this technique which allows simple, safe and easy liver resection. Liver surgeons should, therefore, know the fundamental concept of the Glissonean pedicle transection method. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00534-011-0443-0) contains supplementary material, which is available to authorized users.