Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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 by General 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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
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.

Keywords: Laparoscopic anatomical liver resection; Subsegmentectomy; Laennec membrane; Liver pedicle anatomy; Hepatocellular carcinoma

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.