Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean pedicle approach (with videos).
Couinaud described three fundamental approaches at the hepatic hilus in liver surgery. The Glissonean pedicle approach at the hepatic hilus is one of these procedures and provides anatomical hepatectomy for hepatocellular carcinoma (HCC). The Glissonean pedicle approach was introduced by Couinaud and Takasaki in the early 1980s. The key of the Glissonean pedicle approach is clamping the pedicle first, secondly confirming the territory, which includes the HCC, and finally dissecting the liver parenchyma. This procedure prevents intrahepatic metastasis of HCC, which spreads along the portal vein and improves the overall survival after surgery. Another key feature is that we do not have to consider any variations of the vascular elements in the hepatoduodenal ligament under the hilar plate. This procedure allows an approach to the tertiary branches, which feed a smaller anatomical area than Couinaud's segment. We refer to this area as a cone unit of the liver. The procedure is also available in laparoscopic hepatectomy and provides new knowledge of the surgical anatomy, especially for small anatomical liver resection in the cirrhotic liver.
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. yamamoto@ige.twmu.ac.jp.
Masakazu
M
Yamamoto
Satoshi
S
Katagiri
Shun-ichi
S
Ariizumi
Yoshihito
Y
Kotera
Yutaka
Y
Takahashi
Hiroto
H
Egawa
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D008113:Liver Neoplasms / Q000601:surgery*; D009362:Neoplasm Metastasis / Q000517:prevention & control; D009626:Terminology as Topic
Anatomical hepatectomy; Cone unit of the liver; Hilar plate; Laennec's capsule; Surgical anatomy of the liver; Walaeus sheath