The Glissonean Pedicle Approach: The Takasaki Technique

Abstract

AbstractCouinaud described three main approaches to control the inflow system at the hepatic hilus in liver surgery: the intrafascial, the extrafascial, and the transfissural with extrafascial approach. The intrafascial approach is the so-called control method. The extrafascial approach and the transfissural with extrafascial approach are considered to be the Glissonean pedicle approach. The Glissonean pedicle approach by extrafascial approach is considered to be the Takasaki technique. The key steps of the Takasaki technique are the following: (1) clamping the Glissonean pedicle, (2) confirming the portal territory which includes the tumor, (3) dissecting the liver parenchyma. When the Glissonean pedicles are ligated at the hepatic hilus prior to liver dissection, various types of anatomical hepatectomy, such as right or left hemihepatectomy and various types of sectionectomy can be carried out. When the tertiary branches of the Glissonean pedicles are ligated extra- or intrahepatically, various types of segmentectomy and cone unit resection can be carried out. This procedure is suitable for patients with hepatocellular carcinoma (HCC), because patients with HCC usually have liver dysfunction and HCC often invades the portal vein. The procedure is also available in laparoscopic hepatectomy, because of its simplicity and safety. The Glissonean pedicle approach is, therefore, considered to be one of the most important procedures in liver surgery which can be achieved safely and has oncological benefit.KeywordsAnatomical hepatectomyGlisson’s capsuleLaennec’s capsule