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- 1. PRIMARY HILAR TECHNIQUES FOR ISOLATION OF THE GLISSONIAN PEDICLES IN MAJOR AND MINOR LIVER RESECTIONS Authors: I. C樽mpeanu, 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. MOTTO: Extra-fascial control of the pedicles has been a definite progress and has simplified considerably sectorectomies and segmentectomies Couinaud C., 1989
- 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. Classic hilar dissection: complicated and dangerous A. cistic AH seg IV VPS AHS VPD AHD VP Artera hepatic proprie
- 5. Placa hilar (central) V-VIII Placa glissonian stang Teci glissoniene II VI-VII IV III Placa vezicular Placa ombilical GLISSONIAN PLATES AND SHEATHS
- 6. PGAD PGPD Anatomic variants under the hilar (and ombilical) plate (biliary tract)
- 8. Right hilar extension (detail)
- 9. Ischaemic limits of segment VI (modal distribution)
- 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)
- 13. V(S)HM V(S)HD Plac hilar V(S)HS Takasaki-Couinaud Couinaud Lazorthes Launois Launois COMPLEX EXTRAGLISSONIAN APPROACH HILAR PLATE DESCENDING
- 14. 1 3 Placa Lob ptrat VB (IVb) CUSA VB Hilar plate descending - Couinaud 2 4 Coborarea PH Posterior approach (segment IX)
- 15. Placa cistic Lig rotund IVb IV Linia SPP PPPS PPS (PGPS) PPD PPPD Couinaud (PGPD) Takasaki-Couinaud
- 16. ISOLATION OF THE GLISSONIAN PEDICLES FOR THE LEFT HEMI-LIVER
- 17. Couinaud technique for the isolation of the LPPP (PPPS)
- 18. Launois technique (posterior approach) for the isolation of the LPPP (PPPS). a)=schematic draw
- 19. III IVb Isolation of glissonian pedicles for II and III
- 20. Lig. rotund Pedicul seg. III Pedicul seg. IV Plac ombilical PPPS clampat RESECTION OF SEGMENT III
- 21. 2. 1. Resection of segment III 3. 4.
- 22. Ombilical plate epiportal view
- 23. ISOLATION OF THE GLISSONIAN PEDICLES FOR THE RIGHT HEMI-LIVER
- 24. (IX) TYPE OF PERIHILAR INCISIONS USED FOR EXTRAGLISSONIAN APPROACH
- 25. Placa cistic Lig rotund IVb IV Linia SPP PPPS PPS (PGPS) PPD Couinaud PPPD (PGPD) Takasaki-Couinaud
- 27. LAUNOIS technique for the isolation of the RPPP (PPPD, PGPD)
- 29. Ligature level of the glissonian pedicles (right lobe)
- 30. Posterior approach Launois anatomic portal variant of the right lobe
- 31. Anterior variants of the RPS (SPD)
- 32. 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)
- 33. Scizura port principal Scizura port dreapt
- 34. Linie SPD V.B. Pedicul lateral drept ( clampat ) Modal variant of RPS (SPD)
- 35. SPD V.B. VI Glissonian pedicle for VI clamped (amodal distribution)