Surgical Anatomy of the Liver in the Glissonean Pedicle Approach: What We Need to Know

Abstract

The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy and progresses the technique of liver surgery. The Glissonean pedicle is wrapped by the connective tissue referred to as the Walaeus sheath and includes the hepatic artery, the portal vein, the bile duct, the nerves, and the lymphatic vessels. This approach provides extrafascial access to the hepatic hilus, and the secondary Glissonean pedicles are taped and ligated at the hepatic hilus without liver dissection. The approaching point must be over the hilar plate; therefore, surgeons do not have to consider any variation of the artery or bile ducts. The tertiary branches can be approached through the hepatic hilus or in the liver on the borderlines between the segments. Any anatomical hepatectomy can be done using this technique which allows simple, safe, and easy liver surgery. Liver surgeons should, therefore, know the fundamental concept of the Glissonean pedicle approach.