Standardization of Anatomic Liver Resection Based on Laennec’s Capsule

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 isolation—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 amount. The accumulated histological evidence supported our concept, employing elastic fiber staining as a means of visualization. For the standardization of extrahepatic Glissonean pedicle isolation, it was necessary to accurately approach the six gates marked by four anatomical landmarks to enter a gap between the Glissonean pedicle and the Laennec’s capsule that covers the liver parenchyma. The cystic plate cholecystectomy and division of the anchors facilitate the procedure. For the standardization of the exposure of the hepatic vein—another essential procedure for the anatomic liver resection—it was important to identify the two layers of Laennec’s capsule around the hepatic vein and preserve them by appropriately taking one of the following three approaches: the outer-Laennec, inter-Laennec, and inner-Laennec. The hepatic vein root at first one-way dissection in cranio-caudal direction was quite useful in exposing the hepatic vein. Surgical techniques based on Laennec’s capsule led to all kinds of standardized anatomic liver resection, contributing to establishing a safe standard within hepatobiliary surgery, especially in minimally invasive surgical procedures.