Abstract
BackgroundThe bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.MethodsSeveral surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined.ResultsThe multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area.ConclusionsHistopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.
Highlights
The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components
The serial sections were stained by the Masson trichrome and Sirius red stains to clarify the structure of the connective tissues between the liver and the diaphragm
Sparse connective tissues were lying in a width of 100–200 μm between the liver and the diaphragm in low-magnification micrographs (Fig. 1a, c, and e)
Summary
The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. In the process of human development, a liver grows, rotates, and adheres to the right diaphragm [1, 2]. The attachment site of the liver to the right diaphragm is known as the bare area. The liver surface under the bare area is thought to lack a peritoneal covering in adults [3, 4]. The term, bare area, originates from this recognition. The bare area has a multilayered structure, namely a fused. The aim of this paper was to analyze the structure of the bare area by an integrated study of laparoscopic surgical images and histopathological studies and to describe surgical procedures.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
