J.Jpn. Surg. Soc.. 99(4): 245-250, 1998

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Feature topic

HEPATIC RESECTION USING GLISSONEAN PEDICLE TRANSECTION

The basics of hepatic resection using the glissonean pedicle transection method are presented. The portal triad continues from the hepatoduodenal ligament to the intrahepatic portion in the from of the glissonean pedicle, i.e., the artery, portal vein, and bile duct are combined with connective tissue and sheathed by the peritoneum in the fbrm of a fibroid bundle. The full length of the primary branches and the origin of secondary branches are Iocated extrahepatically, and the trunk of the secondary and more peripheral branches have an intrahepatic course. The ramification pattern of the tertiary branches of each secondary branch varies by individual.
The liver is nourished by the 3 secondary branches of the glissonean pedicle. Each secondary branch supplies one segment, and therefore the liver can be divided into 3 segments and the additional caudate area. The area supplied by each of the tertiary branches is cone shaped (“cone unit”). Each segment is composed of from 6 to 8 cone units. The standard method for hepatic resection is the segmental resection method, in which one secondary branch is transected. In cases of limited resection, the number of cone units to be resected is adjusted, and the tertiary branches which supply them must also be transected selectively through the hilar or parenchymal approach. The author has performed hepatic resection using the glissonean pedicle transection method in 834 consecutive patients with hepatocellular carcinoma with no trouble.

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