Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus

Abstract

We have developed a new method of hepatic resection, in which the cancer-bearing Glissonean code (G-code) branches are served using a hilar approach for an anatomically systematized resection. Since the hepatic artery, portal vein and bile duct are surrounded by connective tissue, the portal triad can be treated as a fibroid code both outside and inside the liver. Compared to the ramification pattern of the hepatic artery, portal vein and bile duct, that of the G-code is simpler. In all our surgical procedures of hepatic resections, the cancer bearing G-code branch is selectively cut using a hilar approach before the dissection of the parenchyma of the liver. We have experienced 168 cases of several types of hepatic resection for hepatocellular carcinoma. Only in three cases was it impossible to accomplish the transection of some third branches using a hilar approach.