How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec’s capsule

• DOI: 10.1007/s00423-021-02282-x
• Publication Date: 2021-07-31T11:02:49Z
• Authors: Shunya Hanzawa; Kazuteru Monden; Masayoshi Hioki; Hiroshi Sadamori; Satoshi Ohno; Norihisa Takakura
• Keywords: Capsule

Abstract Background Laparoscopic anatomic liver resection is technically demanding, given the need to safely isolate Glissonean pedicles and expose hepatic veins (HVs) on parenchyma cut surface. Laennec’s capsule observed around root of HVs. However, its existence, particularly peripheral side HVs, remains controversial. Herein, we describe capsule-related histopathological findings HVs a safe laparoscopic left medial sectionectomy utilizing capsule. Methods The extrahepatic approach was performed by connecting Gates II III, in accordance with Sugioka’s Gate theory. Liver parenchymal transection commenced along demarcation line, which between lateral sections, G4 dissected during transection. Subsequently, via outer-Laennec approach, middle vein (MHV) exposed from cranial view, while preserved. Parenchymal completed MHV line. We obtained membrane surrounding examinations. Results Six patients underwent February 2012 November 2020. There were no cases involving complications (Clavien–Dindo classification; grade or higher), open-surgery conversion, transfusion, surgery-related death. showed both trunk major Conclusions A feasible advantageous procedure for sectionectomy. propose that surrounds entire length