PRIMARY HILAR TECHNIQUES
    FOR ISOLATION OF THE
GLISSONIAN PEDICLES IN MAJOR
AND MINOR LIVER RESECTIONS

Authors: I. Cîm...
MOTTO:

 “Extra-fascial control of the pedicles has
been a definite progress and has simplified
      considerably sectore...
MOTTO:

Glissonean pedicle transection method prevented
    intraoperative metastasis and significantly
 improved the post...
Classic hilar dissection: complicated and dangerous




            A. cistică             AH seg IV


                   ...
Placa hilară (centrală)

              V-VIII                            Placa glissoniană
                               ...
PGAD



       PGPD



Anatomic variants – under the hilar (and ombilical) plate
                     (biliary tract)
Right hilar extension
Right hilar extension (detail)
Ischaemic limits of segment VI (modal distribution)
D




Isolation of the RPGP (PGPD)           Risk of damaging right inferior
 in the Raynaud-Coucoravas            retro-h...
V(S)HM

  V(S)HD                Placă hilară

                                       V(S)HS




Takasaki-Couinaud         ...
1                                3
Placa   Lob pătrat
 VB       (IVb)

                                  CUSA




 VB

   ...
Placa cistică
                             Lig rotund
                       IVb
                        IV



          L...
ISOLATION OF THE GLISSONIAN
PEDICLES FOR THE LEFT HEMI-LIVER
Couinaud technique for the isolation of the LPPP (PPPS)
Launois technique (posterior approach) for the isolation of the LPPP (PPPS).
                             a)=schematic draw
III
IVb




Isolation of glissonian
pedicles for II and III
Lig. rotund




                            Pedicul seg. III

Pedicul seg. IV
                          Placă ombilicală

...
2.
1.
     Resection of segment III




3.                  4.
Ombilical plate – epiportal view
ISOLATION OF THE GLISSONIAN
   PEDICLES FOR THE RIGHT
         HEMI-LIVER
(IX)
TYPE OF PERIHILAR INCISIONS USED FOR
    EXTRAGLISSONIAN APPROACH
Placa cistică
                           Lig rotund
                     IVb
                      IV



        Linia
   ...
SUPRAHILAR LAZORTHES APPROACH
LAUNOIS technique for the isolation of the RPPP
              (PPPD, PGPD)
Dangerous Launois zone
Ligature level of the glissonian pedicles (right lobe)
Posterior approach Launois – anatomic portal variant of the right lobe
Anterior variants of the RPS (SPD)
SPD


      Sector paramedian drept




                               SPP



Fosa V.B.
                 Ischaemic limits ...
Scizura
                portă principală



   Scizura
portă dreaptă
Linie SPD



                             V.B.




                             Pedicul lateral drept
                    ...
SPD



                                              V.B.




                      VI




Glissonian pedicle for VI – cla...
13
13
Upcoming SlideShare
Loading in …5
×

13

1,074 views

Published on

Primary hilar techniques for isolation of the glissonian pedicles in major an minor liver resections

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,074
On SlideShare
0
From Embeds
0
Number of Embeds
23
Actions
Shares
0
Downloads
59
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

13

  1. 1. PRIMARY HILAR TECHNIQUES FOR ISOLATION OF THE GLISSONIAN PEDICLES IN MAJOR AND MINOR LIVER RESECTIONS Authors: I. Cîmpeanu, M. Bogdan, T. Artenie, R. Petrescu, I. Lucescu Clinical 1-st Department of Surgery– Clinical and Emergency Central Military Hospital “Dr. Carol Davila” - Bucharest April 2003
  2. 2. MOTTO: “Extra-fascial control of the pedicles has been a definite progress and has simplified considerably sectorectomies and segmentectomies” Couinaud C., 1989
  3. 3. MOTTO: Glissonean pedicle transection method prevented intraoperative metastasis and significantly improved the postoperative survival in patients with hepatocellular carcinoma. Tsuruta K. &col., Hepato-Gastroenterology 2002
  4. 4. Classic hilar dissection: complicated and dangerous A. cistică AH seg IV VPS AHS VPD AHD VP Artera hepatică proprie
  5. 5. Placa hilară (centrală) V-VIII Placa glissoniană stangă Teci glissoniene II VI-VII IV III Placa veziculară Placa ombilicală GLISSONIAN PLATES AND SHEATHS
  6. 6. PGAD PGPD Anatomic variants – under the hilar (and ombilical) plate (biliary tract)
  7. 7. Right hilar extension
  8. 8. Right hilar extension (detail)
  9. 9. Ischaemic limits of segment VI (modal distribution)
  10. 10. D Isolation of the RPGP (PGPD) Risk of damaging right inferior in the Raynaud-Coucoravas retro-hepatic vein (VRHID) when point (RC) attempting to isolate RPGP (PGPD) - VI (A)=PG angular segment VI - (cadaverous dissection)
  11. 11. V(S)HM V(S)HD Placă hilară V(S)HS Takasaki-Couinaud Couinaud Lazorthes Launois Launois COMPLEX EXTRAGLISSONIAN APPROACH HILAR PLATE DESCENDING
  12. 12. 1 3 Placa Lob pătrat VB (IVb) CUSA VB Hilar plate descending - Couinaud 2 4 Coborarea PH Posterior approach (segment IX)
  13. 13. Placa cistică Lig rotund IVb IV Linia SPP PPPS PPS (PGPS) PPD PPPD Couinaud (PGPD) Takasaki-Couinaud
  14. 14. ISOLATION OF THE GLISSONIAN PEDICLES FOR THE LEFT HEMI-LIVER
  15. 15. Couinaud technique for the isolation of the LPPP (PPPS)
  16. 16. Launois technique (posterior approach) for the isolation of the LPPP (PPPS). a)=schematic draw
  17. 17. III IVb Isolation of glissonian pedicles for II and III
  18. 18. Lig. rotund Pedicul seg. III Pedicul seg. IV Placă ombilicală PPPS clampat RESECTION OF SEGMENT III
  19. 19. 2. 1. Resection of segment III 3. 4.
  20. 20. Ombilical plate – epiportal view
  21. 21. ISOLATION OF THE GLISSONIAN PEDICLES FOR THE RIGHT HEMI-LIVER
  22. 22. (IX) TYPE OF PERIHILAR INCISIONS USED FOR EXTRAGLISSONIAN APPROACH
  23. 23. Placa cistică Lig rotund IVb IV Linia SPP PPPS PPS (PGPS) PPD Couinaud PPPD (PGPD) Takasaki-Couinaud
  24. 24. SUPRAHILAR LAZORTHES APPROACH
  25. 25. LAUNOIS technique for the isolation of the RPPP (PPPD, PGPD)
  26. 26. Dangerous Launois zone
  27. 27. Ligature level of the glissonian pedicles (right lobe)
  28. 28. Posterior approach Launois – anatomic portal variant of the right lobe
  29. 29. Anterior variants of the RPS (SPD)
  30. 30. SPD Sector paramedian drept SPP Fosa V.B. Ischaemic limits of the anterior (paramedian) sector of the right lobe, with the visualisation of the MPS and RPS (anterior right glissonian pedicle clamped) – amodal variant of RPS (SPD)
  31. 31. Scizura portă principală Scizura portă dreaptă
  32. 32. Linie SPD V.B. Pedicul lateral drept ( clampat ) Modal variant of RPS (SPD)
  33. 33. SPD V.B. VI Glissonian pedicle for VI – clamped (amodal distribution)

×