Three-dimensional CT reconstruction of the hepatic pedicle based on the Laennec’s capsule and the development and validation of extra-sheath dissection/occlusion clamp

Zhiyu LIN; Xin XIA; Huan LEI; Yuchuan LUO; Long CHENG; Hongyin LIANG; Tao WANG

doi:10.12449/JCH251023

Volume 41 Issue 10

Oct. 2025

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Article Navigation > Journal of Clinical Hepatology > 2025 > 41(10): 2118-2124

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Three-dimensional CT reconstruction of the hepatic pedicle based on the Laennec’s capsule and the development and validation of extra-sheath dissection/occlusion clamp

DOI: 10.12449/JCH251023

Zhiyu LIN^{1, 3},
Xin XIA^{1, 3},
Huan LEI^{2, 3},
Yuchuan LUO³,
Long CHENG³,
Hongyin LIANG³,
Tao WANG^{2, 3
,
,
,}

1.
Department of Hepatopancreatobiliary Surgery，School of Clinical Medicine Southwest Medical University, Luzhou，Sichuan 646000，China
2.
Graduate School，Southwest Medical University Southwest Medical University，Luzhou，Sichuan 646000，China
3.
Department of Hepatobiliary Surgery，The General Hospital of Western Theater Command，Chengdu 610083，China

Research funding:

The General Hospital of Western Theater Command Management Project (41C4168C)

More Information

Corresponding author: WANG Tao， watopo@163.com （ORCID： 0000-0002-0005-0994）
Received Date: 2025-03-01
Accepted Date: 2025-05-19
Published Date: 2025-10-25

Abstract

Abstract

Objective To investigate the anatomical features of three-dimensional （3D） reconstruction of the hepatic pedicle based on the Laennec’s capsule， as well as its application value in the development of extra-sheath dissection/occlusion clamp and precise hepatectomy. Methods A retrospective analysis was performed for the abdominal contrast-enhanced CT data of 100 patients without anatomical abnormalities of the hepatic pedicle in The General Hospital of Western Theater Command from January 2021 to June 2024. The Hisense CAS system combined with the 3D U-net deep learning algorithm was used for 3D reconstruction of the hepatic pedicle at the level of Laennec’s capsule， and the hepatic pedicle was measured in terms of the length， outer diameter， and angle of the main trunk and branches. An extra-sheath hepatic pedicle dissection/occlusion clamp was developed based on the above measurements， and a total of 30 patients scheduled for right hemihepatectomy were enrolled and randomly divided into device group and control group， with 15 patients in each group. The two groups were compared in terms of hepatic pedicle handling time， time of operation， intraoperative blood loss， and the incidence rate of bile duct injury. The independent-samples t test was used for comparison of continuous data between two groups， and the Fisher’s exact test was used for comparison of categorical data between two groups. Results The results of 3D reconstruction revealed four variants in the main trunk branches of the hepatic pedicle， with type Ⅰ （left-right branching） accounting for 88% （88/100）， type Ⅱ （trifurcation type） accounting for 5% （5/100）， type Ⅲ （right anterior branching） accounting for 5% （5/100）， and type Ⅳ （special type） accounting for 2% （2/100）. The outer diameter of the main hepatic pedicle was 24.10±6.16 mm， the length of the left main branch was 20.59±6.38 mm， and the length of the right main branch was 21.99±7.98 mm. Compared with the control group， the device group had significantly shorter hepatic pedicle handling time （14.10±1.30 minutes vs 17.50±2.00 minutes， t=-5.620， P=0.001） and time of operation （217.00±28.28 minutes vs 241.87±19.49 minutes， t=-2.804， P=0.009）. The device group had a significantly lower incidence rate of bile duct injury than the control group （0 vs 20%， P=0.031）. Conclusion 3D reconstruction based on the Laennec’s capsule can accurately display the anatomical variations of the hepatic pedicle. The extra-sheath hepatic pedicle dissection/occlusion clamp developed based on such data can optimize the process of hepatic pedicle management and improve surgical safety， and therefore， it holds promise for clinical application.
- Digestive System Surgical Procedures,
- Imaging， Three-Dimensional,
- Laennec’s Membrane,
- Surgical Instruments

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References

[1]	COUINAUD C. Liver lobes and segments: Notes on the anatomical architecture and surgery of the liver[J]. Presse Med( 1893), 1954, 62( 33): 709- 712.
[2]	MORIMOTO M, MATSUO Y, NONOYAMA K, et al. Glissonean pedicle isolation focusing on the laennec’s capsule for minimally invasive anatomical liver resection[J]. J Pers Med, 2023, 13( 7): 1154. DOI: 10.3390/jpm13071154.
[3]	EGUCHI S, KANEMATSU T, ARII S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey[J]. Surgery, 2008, 143( 4): 469- 475. DOI: 10.1016/j.surg.2007.12.003.
[4]	WANG K, SUN SB, LI ZX, et al. Application value of cystic plate approach for extrahepatic right hepatic pedicle dissection in minimally invasive anatomic liver resection[J]. Chin J Dig Surg, 2023, 22( 4): 489- 496. DOI: 10.3760/cma.j.cn115610-20230321-00119. 王恺, 孙世波, 李芷西, 等. 胆囊板入路右肝蒂鞘外解剖法在微创解剖性肝切除术中的应用价值[J]. 中华消化外科杂志, 2023, 22( 4): 489- 496. DOI: 10.3760/cma.j.cn115610-20230321-00119.
[5]	SHIRATA C, KOKUDO T, GILLET M, et al. Reappraisal of laennec’s capsule[J]. Surg Oncol, 2020, 33: 222- 223. DOI: 10.1016/j.suronc.2019.08.004.
[6]	SUGIOKA A, KATO Y, TANAHASHI Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: Proposal of a novel comprehensive surgical anatomy of the liver[J]. J Hepatobiliary Pancreat Sci, 2017, 24( 1): 17- 23. DOI: 10.1002/jhbp.410.
[7]	MONDEN K, OHNO K, HAYASHI S, et al. Hepatic vein anatomy related to Laennec’s capsule for liver resection[J]. J Hepatobiliary Pancreat Sci, 2023, 30( 5): 551- 557. DOI: 10.1002/jhbp.1250.
[8]	SHENG WW, YUAN CD, WU LQ, et al. Clinical application of a three-dimensional reconstruction technique for complex liver cancer resection[J]. Surg Endosc, 2022, 36( 5): 3246- 3253. DOI: 10.1007/s00464-021-08636-2.
[9]	LAI JL, WU JY, BAI YN, et al. A novel Laennec’s capsule tunnel approach for pure laparoscopic left hemihepatectomy: A propensity score matching study[J]. Front Surg, 2023, 10: 1136908. DOI: 10.3389/fsurg.2023.1136908.
[10]	ZHANG H, ZHOU TY, LIU H, et al. Clinical application of hepatic portal vein anatomy and three-dimensional reconstruction of images[J]. Acta Anat Sin, 2020, 51( 6): 919- 923. DOI: 10.16098/j.issn.0529-1356.2020.06.017. 张慧, 周庭永, 刘晖, 等. 肝门静脉解剖和影像三维重建的临床应用[J]. 解剖学报, 2020, 51( 6): 919- 923. DOI: 10.16098/j.issn.0529-1356.2020.06.017.
[11]	HONG HY, CHEN ZJ, CHI XB, et al. Comparative study of extrathecal and intrathecal Glisson’s pedicle transection in laparoscopic anatomic hepatectomy[J/OL]. Chin J Hepatic Surg Electron Ed, 2024, 13( 1): 21- 26. 洪汉崟, 陈志坚, 池小斌, 等. 鞘外法和鞘内法Glisson蒂阻断在腹腔镜解剖性肝切除中应用的对比研究[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13( 1): 21- 26.
[12]	KIGUCHI G, SUGIOKA A, KATO Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position[J]. Surg Oncol, 2019, 29: 140- 141. DOI: 10.1016/j.suronc.2019.05.001.
[13]	MONDEN K, SADAMORI H, HIOKI M, et al. Laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach[J]. Surg Oncol, 2020, 35: 299- 300. DOI: 10.1016/j.suronc.2020.08.029.
[14]	HU W, ZHANG GM, CHEN M, et al. Laennec’s approach for laparoscopic anatomical hemihepatectomy[J]. World J Surg Oncol, 2021, 19( 1): 295. DOI: 10.1186/s12957-021-02404-1.
[15]	ZHANG CH, MA JL, ZHOU Y. Laparoscopic dissection of the first and second porta hepatis along Laennec’s capsule via“Hepatic Serosal Incision” approach: How I do it[J]. World J Surg, 2024, 48( 8): 1967- 1972. DOI: 10.1002/wjs.12255.
[16]	YANG Y, YU CY, LIN F, et al. Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy[J]. ANZ J Surg, 2024, 94( 4): 655- 659. DOI: 10.1111/ans.18907.
[17]	LI BH, YIN DL, ZHANG QF, et al. Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: A multicenter cohort study[J]. Int J Surg, 2025, 111( 2): 1929- 1938. DOI: 10.1097/JS9.0000000000002212.
[18]	JIANG C, WANG HJ, REN L, et al. Application status of three- dimensional CT reconstruction in hepatobiliary surgery[J]. J Clin Hepatol, 2017, 33( 2): 389- 393. DOI: 10.3969/j.issn.1001-5256.2017.02.041. 姜超, 王海久, 任利, 等. CT三维重建在肝胆外科的应用现状[J]. 临床肝胆病杂志, 2017, 33( 2): 389- 393. DOI: 10.3969/j.issn.1001-5256.2017.02.041.
[19]	ZHANG YP, SHI N, ZOU YP, et al. The characteristics of Laennec’s capsule around the hepatic veins: A histological study based on 71 liver surgical specimens[J]. Ann Gastroenterol Surg, 2022, 7( 2): 287- 294. DOI: 10.1002/ags3.12618.
[20]	HU Y, SHI J, WANG SH, et al. Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule[J]. BMC Gastroenterol, 2019, 19( 1): 194. DOI: 10.1186/s12876-019-1107-9.
[21]	CAO SD, LI H, DONG SY, et al. Feasibility study of intelligent three-dimensional accurate liver reconstruction technology based on MRI data[J]. Front Med(Lausanne), 2022, 9: 834555. DOI: 10.3389/fmed.2022.834555.
[22]	HUANG XL, LU S. A Meta-analysis comparing the effect of anatomical resection vs. non-anatomical resection on the long-term outcomes for patients undergoing hepatic resection for hepatocellular carcinoma[J]. HPB(Oxford), 2017, 19( 10): 843- 849. DOI: 10.1016/j.hpb.2017.06.003.
[23]	KANG WH, KIM KH, JUNG DH, et al. Long-term results of laparoscopic liver resection for the primary treatment of hepatocellular carcinoma: Role of the surgeon in anatomical resection[J]. Surg Endosc, 2018, 32( 11): 4481- 4490. DOI: 10.1007/s00464-018-6194-0.

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Three-dimensional CT reconstruction of the hepatic pedicle based on the Laennec’s capsule and the development and validation of extra-sheath dissection/occlusion clamp

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Three-dimensional CT reconstruction of the hepatic pedicle based on the Laennec’s capsule and the development and validation of extra-sheath dissection/occlusion clamp

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