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Fig. 5 | BMC Gastroenterology

Fig. 5

From: Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule

Fig. 5

Hanging maneuver with Laennec’s approach for LAH Laennec’s capsule with H&E staining around the IVC was located with the arrow in (a) and (b). A thick elastic lamina is observed covering the entire IVC, with a gap (arrows). (a) and (b) are views under 20× and 100× magnification, respectively. (b) is a higher magnification view of the square in (a). (c) and (d) show the Hanging maneuver. (e) Sketch map of Laennec’s capsule and Laennec’s approach for hepatectomy. Sketch map of Laennec’s capsule is referred to Sugioka’s study in 2017. Laennec’s capsule is marked with a brown line and was observed as a continuous dense fibrous layer surrounding the whole liver independent of the serosa, Glissonean pedicle, cystic plate, and hepatic veins. The well-defined gaps between Laennec’s capsule and the surrounding tissues were identified after dissecting the visceral peritoneum. Laennec’s approach for a hepatectomy includes mobilizing the liver, isolating the Glissonean pedicle and hepatic vein, and performing Hanging maneuver. These steps were numbered sequentially.

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