Anatomical basis for the intrahepatic glissonian approach during hepatectomies

Background

Anatomical liver resections are based on some basic technical principles such asvascular control, ischemic area delineation to be resected and maximum parenchymalpreservation. These aspects are achieved by the intrahepatic glissonian approach,which consists in accessing the pedicles of hepatic segments within the hepaticparenchyma. Small incisions on well-defined anatomical landmarks are performed toapproach the pedicles, making dissection of the hilar plate unnecessary.

Aim

Analyze parameters in liver anatomy related to intrahepatic surgical technique toglissonians pedicles, to set the normal anatomy related to the procedure andthereby facilitate the attainment of this technique.

Methods

Anatomical parameters related to the intrahepatic glissonian approach were studiedin 37 cadavers. Measurements were performed with precision instruments. Data wereexpressed as mean±standard deviation. The subjects were divided into groupsaccording to gender and liver weight and groups were compared statistically.

Results

Twenty-five cadavers were male and 12 female. No statistically significantdifference was observed in virtually all parameters when groups were compared.This demonstrates the consistency of the anatomical parameters related to theintrahepatic glissonian approach.

Conclusion

The results obtained in this study made possible major technical advances in therealization of open and laparoscopic hepatectomies with intrahepatic glissonianapproach, and can help surgeons to perform liver resections by this method.