Histology of the Laennec’s Capsule around the Hepatic Veins and How it May Guide Approaches to Laparoscopic Anatomic Lliver Resection

Abstract

Laennec’s capsule is a proper membrane of the liver, first described by Réné T. H. Laennec in 1802, covering not only the entire surface of the liver but also the intrahepatic parenchyma surrounding the Glissonean pedicles and the hepatic veins (HVs). It is an essential structure for establishing liver resection, especially anatomic liver resection, which involves the isolation of the extrahepatic Glissonean pedicles and the exposure of the main HVs. Regarding the location of the capsule, Laennec and Couinaud described it as adjacent to the confluence of the main HVs. Whereas, Hayashi revealed it to be around the peripheral branches. Recently, Kiguchi first reported that Laennec’s capsule consists of two layers and proposed novel surgical procedures using this concept. Yet, its existence is still debated. Herein, we show the precise anatomy and histology of Laennec’s capsule around the HVs including its two-layered composition: one derived from the pericardium (the cardiac Laennec’s capsule) and the other from the proper membrane (the hepatic Laennec’s capsule). Using these findings, we demonstrate three surgical approaches to the main HVs and emphasize the significance of the craniocaudal parenchymal dissection especially for laparoscopic anatomic liver resection.