Ramification 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 ramification 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 ramification 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 configuration, the ramification 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 ramification pattern.