Abstract
Glisson's capsule was discovered by Johannis Walaeus in 1640 and described by Francis Glisson in 1654. The capsule wraps the hepatic artery, the portal vein and the bile duct in the liver and forms bundles at the hepatic hilus and in the liver as the Glissonean pedicle tree. Glisson's capsule does not connect to the proper membrane of the liver, which was discovered by Laennec; therefore, the Glissonean pedicles can be detached from the liver parenchyma without liver dissection. Couinaud described three main approaches to control the inflow system at the hepatic hilus in liver surgery; the intrafascial approach, the extrafascial and transfissural approach, and the extrafascial approach. The intrafascial approach is the so‐called control method. The extrafascial and transfissural approach, and the extrafascial approach are recognized as the Glissonean pedicle approach. When the Glissonean pedicles are ligated before liver transection, various types of anatomical hepatectomy can be carried out. The Glissonean pedicle approach is, therefore, considered to be one of the most important procedures in liver surgery. We herein describe the historical aspects and procedures of the Glissonean pedicle approach in liver surgery.
Highlights
Couinaud was convinced that Glisson’s capsule was the most important component of the liver in his book entitled Surgical Anatomy of the Liver Revisited.[1]
The portal vein, the hepatic artery and the bile duct are wrapped in a connective tissue (Glisson’s capsule) which accompanies them up to the liver parenchyma
This connective tissue forms a thick plate at the hepatic hilus
Summary
Couinaud was convinced that Glisson’s capsule was the most important component of the liver in his book entitled Surgical Anatomy of the Liver Revisited.[1]. If the main portal fissure or the left suprahepatic fissure is opened after liver parenchyma dissection, the surgeon can confirm the Glissonean pedicles which arise from the hilar plate or the umbilical plate This procedure is referred to as the extrafascial and transfissural approach. The Glissonean pedicles can be separated from Laennec’s capsule and the main portal pedicles and the sectional and segmental pedicles can be approached at the hepatic hilus without liver dissection.[21]. This procedure could guide the precise identification of the ligating point of the portal pedicle so that subsegmentectomy could be carried out
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