title: Anatomical basis for the intrahepatic glissonian approach during hepatectomies.
abstract: BACKGROUND
  Anatomical liver resections are based on some basic technical principles such as vascular control, ischemic area delineation to be resected and maximum parenchymal preservation. These aspects are achieved by the intrahepatic glissonian approach, which consists in accessing the pedicles of hepatic segments within the hepatic parenchyma. Small incisions on well-defined anatomical landmarks are performed to approach the pedicles, making dissection of the hilar plate unnecessary.
  
  
  OBJECTIVE
  Analyze parameters in liver anatomy related to intrahepatic surgical technique to glissonians pedicles, to set the normal anatomy related to the procedure and thereby facilitate the attainment of this technique.
  
  
  METHODS
  Anatomical parameters related to the intrahepatic glissonian approach were studied in 37 cadavers. Measurements were performed with precision instruments. Data were expressed as mean±standard deviation. The subjects were divided into groups according to gender and liver weight and groups were compared statistically.
  
  
  RESULTS
  Twenty-five cadavers were male and 12 female. No statistically significant difference was observed in virtually all parameters when groups were compared. This demonstrates the consistency of the anatomical parameters related to the intrahepatic glissonian approach.
  
  
  CONCLUSIONS
  The results obtained in this study made possible major technical advances in the realization of open and laparoscopic hepatectomies with intrahepatic glissonian approach, and can help surgeons to perform liver resections by this method.
authors.affiliation: Department of Surgery, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo Cañada Trofo
authors.initials: RC
authors.lastname: Surjan
authors.affiliation: Department of Surgery, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Fábio Ferrari
authors.initials: FF
authors.lastname: Makdissi
authors.affiliation: Department of Surgery, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Marcel Autran Cesar
authors.initials: MA
authors.lastname: Machado
mesh_terms: D002102:Cadaver; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D008297:Male