RamiWcation of glisson's sheath peripheral branches and clinical implications in the era of local ablation therapy

Purpose Classical anatomical resection does not always guarantee tumor-free margins when the tumor overrides traditional anatomical planes. Surgeons and interventionists frequently need to focus on the peripheral branches of Glisson's sheath in patients with poor hepatic reserves, particularly when the tumor is deep seated. The present study used anatomical liver dissection to investigate the spatial distribution of the branches of Glisson's sheath in each of four liver sectors. Methods Sixty-four adult human liver specimens were dissected. The size and ramiWcation patterns of Glisson's sheath in each sector were analyzed in terms of bilateral homology within two paramedian sectors and within two lateral sectors. Results Each liver sector had a characteristic Glisson's sheath in terms of trunk shape and ramiWcation pattern. The two paramedian sectors showed point symmetry. Most of the branches of the two paramedian sectors emerged from the top of a short stout trunk. Although the two paramedian sectors were similar in terms of basic conWguration, the ramiWcation axes were almost perpendicular to each other. Unlike the paramedian sectors, the two lateral sectors showed not much homology. Conclusions The peripheral branches of Glisson's sheath were generally longer (approximately 5 cm) and thicker than anticipated. Extirpation strategies should take into account that each liver sector has a characteristic Glisson's sheath ramiWcation pattern.