Wang SD, Wang L, Xiao H, Chen K, Liu JR, Chen Z, Lan X. Novel techniques of liver segmental and subsegmental pedicle anatomy from segment 1 to segment 8. World J Gastrointest Surg 2024; 16(12): 3806-3817 [PMID: 39734440 DOI: 10.4240/wjgs.v16.i12.3806]
Corresponding Author of This Article
Xiang Lan, MD, PhD, Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. lanxiangkeyan@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Wang SD, Wang L, Xiao H, Chen K, Liu JR, Chen Z, Lan X. Novel techniques of liver segmental and subsegmental pedicle anatomy from segment 1 to segment 8. World J Gastrointest Surg 2024; 16(12): 3806-3817 [PMID: 39734440 DOI: 10.4240/wjgs.v16.i12.3806]
World J Gastrointest Surg. Dec 27, 2024; 16(12): 3806-3817 Published online Dec 27, 2024. doi: 10.4240/wjgs.v16.i12.3806
Novel techniques of liver segmental and subsegmental pedicle anatomy from segment 1 to segment 8
Shao-Dong Wang, Li Wang, Heng Xiao, Kai Chen, Jia-Rui Liu, Zhu Chen, Xiang Lan
Shao-Dong Wang, Heng Xiao, Kai Chen, Jia-Rui Liu, Zhu Chen, Xiang Lan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Li Wang, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing 401120, China
Author contributions: All authors contributed to the study concept and design. Lan X performed all surgeries, supervised the research process and revised the article critically for important intellectual content; Wang SD, Xiao H, Chen K, Liu JR, and Chen Z contributed to the material preparation, data collection and analysis; Wang L made the video; Wang SD wrote the first draft of the manuscript. All authors commented on previous versions of the manuscript, read and approved the final manuscript.
Supported byGeneral Project of Natural Science Foundation of Chongqing, No. cstc2021jcyj-msxmX0604; and Chongqing Doctoral “Through Train” Research Program, No. CSTB2022BSXM-JCX0045.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. K2023-053).
Informed consent statement: All subjects understood and agreed to the study protocol and voluntarily signed the informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Corresponding author: Xiang Lan, MD, PhD, Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. lanxiangkeyan@163.com
Received: March 27, 2024 Revised: August 30, 2024 Accepted: September 14, 2024 Published online: December 27, 2024 Processing time: 244 Days and 17.8 Hours
Abstract
BACKGROUND
Laparoscopic anatomical liver resection has become more challenging because some subsegmental Glissonean pedicles are hard to dissect. Here, we introduce how to dissect every (sub) segmental Glissonean pedicle from the first porta hepatis and perform standardized (sub) segmentectomy [from segment 1 (S1) to S8].
AIM
To summarize our methods of laparoscopic anatomical segmental and subsegmental liver resection.
METHODS
The Glisson sheath and liver capsule were separated along the Laennec membrane. The Glissonean pedicle could be isolated and transected with little or no parenchymal damage through this extra-Glissonean dissection approach. The basin of the (sub) segment was determined by the ischemia demarcation line or indocyanine green staining. The hepatic vein or intersegmental vein was also used to guide the plane of parenchymal transection.
RESULTS
All segmental or subsegmental pedicles or even the pedicle of the cone unit could be dissected along the Laennec membrane using our novel technique through the first porta hepatis. The dorsal branches of S8, the branches of S4a and the paracaval portion branches (b/c vein) of the caudate lobe were the most difficult to dissect.
CONCLUSION
The novel techniques of liver segmental and subsegmental pedicle anatomy is feasible for laparoscopic liver resection and can help accurately guide (sub) segmentectomy from S1 to S8.
Core Tip: We achieved laparoscopic anatomical segmental or subsegmental liver resection through our novel techniques. Using this method, we can access the hepatic pedicle of each individual cone unit and perform resection of the portal vein basin associated with that cone unit. And we standardize the detailed steps of anatomical hepatic resection and show the acquisition of key points. It has a positive effect on the promotion and development of anatomical liver resection worldwide.
