Abstract
BackgroundAlthough isolating Glissonean pedicles and hepatic veins are critical procedures during anatomical hepatectomy, there is no standardized approach. We propose the novel Laennec’s approach for laparoscopic anatomic hepatectomy (LAH) based on Laennec’s capsule, which serves as the anatomic landmark for LAH. The aim of this study was to elucidate that the natural gap between Laennec’s capsule and the adjacent tissues contributes to standardization of the surgical technique for LAH.MethodsEighty-four cases were enrolled in this observable clinical trial. They underwent LAH for liver diseases. Laennec’s approach was proposed for LAH based on Laennec’s capsule. The liver tissues close to Glissonean pedicle, hepatic veins, naked area, and inferior vena cava were collected for hematoxylin and eosin, resorcinol-fuchsin staining, and immunohistochemistry.ResultsThe staining revealed capsule packaging of the whole liver independent of the adjacent tissues and intrahepatic vessels. A natural gap was found between Laennec’s capsule and the adjacent tissues at different sites. Laennec’s capsule served as the landmark for isolating Glissonean pedicle and hepatic veins, mobilizing the liver, and performing Hanging maneuver. Eighty-four cases underwent LAH for liver diseases using this strategy. The operation time was 277.23 min. The mean of hospital days was 9.8.ConclusionsLaennec’s approach based on Laennec’s capsule contributes to standardization of the surgical technique for LAH, and brings innovations that facilitates safe and effective liver resection under laparoscopy.
Highlights
Isolating Glissonean pedicles and hepatic veins are critical procedures during anatomical hepatectomy, there is no standardized approach
Laennec’s capsule packages the whole parenchyma independent of the adjacent tissues and intrahepatic vessels We focused on the elastic fibers, which are known to be distributed in the serosal membrane of the viscera, to histologically confirm the presence of Laennec’s capsule
A similar fibrous layer was observed on the outside of the Glissonean pedicle (Fig. 1d, e), as a lining of the hepatic veins (Fig. 1g, h) and the inferior vena cava (IVC) wall (Fig. 1j, k)
Summary
Isolating Glissonean pedicles and hepatic veins are critical procedures during anatomical hepatectomy, there is no standardized approach. There is no definitive approach for the hepatic vein or the Glissonean pedicles isolation, there are three approaches for the pedicles, i.e., intrafascial, and extrafascial with or without destruction of the parenchyma [3]. The surgical technique for isolating the inflow and outflow has not been standardized due to a lack of anatomical understanding In 2017 Sugioka conducted a precise histological study of the liver and showed that Laennec’s capsule is a dense fibrous layer beneath the serosa, on the surface of the bare area, Glissonean pedicle, cystic fossa, and hepatic vein [7]
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