Surgery, Gastroenterology and Oncology

Read article Precise knowledge of liver anatomy is recognized as the key to a safe and efficient liver resection passing in the right surgical plan, often following hepatic veins, while preserving sufficient residual parenchyma with adequate regeneration capacity.
Our knowledge of liver anatomy has evolved over centuries through numerous depictions culminating with the breakthrough description of liver segments produced by Claude Couinaud. His work was rapidly adopted and further developed by Japanese surgeons with the aim of gathering more sophisticated descriptive details in order to furt....[more]

Read article We proposed a novel comprehensive surgical anatomy of the liver based on Laennec's capsule in 2017, which contributed to the standardization of extrahepatic Glissonean pedicle isolationâ?"the optimal method for Glissonean pedicle isolation without parenchymal destruction.
Thereafter, the scope of our concept included an extension to the hepatic vein and the plate system to establish the surgical technique of the anatomic liver resection that consisted of extrahepatic Glissonean pedicle isolation, exposure of the landmark hepatic vein, and parenchymal reresection to the optimum....[more]

Read article Background: Glissonean pedicle isolation is a very useful procedure during a laparoscopic anatomic hepatectomy (LAH); however, few studies have reported the precise layer structure around a Glissonean pedicle.
The aim of this study was to evaluate the layer structure around a Glissonean pedicle in cadaveric models and determine whether Glissonean pedicle isolation based on the layer structure can serve as a standard surgical procedure during a LAH.

Methods: From April 2017 to December 2019, LAHs were performed in 59 patients. Prior to the LAH, a cadaveri....[more]

Read article Laennec's capsule is a proper membrane of the liver, first described by Rene T. H. Laennec in 1802, covering not only the entire surface of the liver but also the intrahepatic parenchyma surrounding the Glissonean pedicles and the hepatic veins (HVs).
It is an essential structure for establishing liver resection, especially anatomic liver resection, which involves the isolation of the extrahepatic Glissonean pedicles and the exposure of the main HVs. Regarding the location of the capsule, Laennec and Couinaud described it as adjacent to the confluence of the main HVs.
Whe....[more]

Read article Laparoscopic left hemihepatectomy (LLH) is one of the major hepatectomy procedures and its surgical techniques are not well standardized. According to our surgical strategies for anatomic liver resections, which are composed of the extrahepatic Glissonean pedicle approach (GPA) and hepatic vein (HV) root-at first one-way parenchymal dissection, we have standardized the surgical techniques for LLH.
Both approaches are based on the anatomical background of Laennec's capsule. The right and left sides of the root of the Glissonean pedicle including the umbilical portion of the porta....[more]

Read article Laparoscopic central bisectionectomy (LCBS) is a highly advanced procedure for centrally located liver tumors. According to our approaches for anatomic liver resection composed of the Laennec's capsule-based extrahepatic Glissonean pedicle approach (GPA) and hepatic vein (HV) root-at first one-way parenchymal resection, we have standardized techniques for LCBS.
The extrahepatic GPA starts with cystic cholecystectomy facilitating extrahepatic isolation of the anterior section pedicle (G-ant), which is ligated. The segment IV pedicle (G-IV) is isolated extrahepatically.
Und....[more]

Read article Anatomic resection of the segment VIII (SVIII) of the liver (segmentectomy VIII) is technically demanding either in open or laparoscopic procedure. Our approaches to anatomic liver resections are composed of the extrahepatic Glissonean pedicle approach (GPA) to isolate hilar pedicles and hepatic vein (HV) root-at first one-way resection of liver parenchyma in the cranio-caudal direction starting from the landmark HV root.
Both techniques are based on Laennec's capsule. Herein, we describe our standardized techniques for open and laparoscopic segmentectomy VIII. The standardized....[more]

Read article Isolated caudate lobectomy (ICL) is technically demanding and its surgical techniques are not standardized. Herein, we describe our method of open and laparoscopic ICL by the extrahepatic Glissonean pedicle approach (GPA) and hepatic vein (HV) root-at first one-way parenchymal resection, which are both based on Laennec's capsule.
Firstly, all the Glissonean pedicles of the caudate lobe are isolated and divided extrahepatically without parenchymal dissection. We have devised two different techniques for the extrahepatic pedicle control. One is "the central hilar technique", wher....[more]

Read article The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. Extrafascial dissection of Glissonean pedicle without opening the liver substance, proposed by Takasaki, represents an effective and safe technique of anatomic liver resection.
Presented approach allows early and easy ischemic delineation of appropriate anatomic liver territory (hemiliver, section or segment) to be removed with selective inflow vascular control. It is not time consuming and it is very useful in re-resection, a....[more]