Standardization of anatomical liver resection on the basis of novel concepts of Laennec's capsule and one-way hepatic resection

Abstract

Introduction: Anatomical liver resection is an essential procedure for safety and curability. However, the procedure has not been fully established at present. Methods: We proposed a novel anatomical concept on the basis of Laennec's capsule and also proposed a novel surgical concept of one-way hepatic resection. Laennec's capsule is the proper membrane that covers not only an entire surface of the liver but also the intrahepatic parenchyma surrounding the Glissonean pedicles and the main hepatic veins as well. Results: This concept enabled systematic extrahepatic Glissonean pedicle and hepatic vein approach. One-way hepatic resection means consistent unidirectional parenchymal dissection from the confluence along the trunk of the major hepatic veins after the isolation of the targeted Glissonean pedicles that allowed standardizing accurate anatomical resection. Based on both concepts, the difficult anatomical liver resections such as anterior sectionectomy, segmentectomy8 or isolated total caudate lobectomy would be well standardized. Conclusion: Our novel concepts would contribute to establish and standardize anatomical liver resection.