Abstract
In 1988, Takasaki proposed a novel anatomical concept for liver surgery, suggesting that targeted pedicles could be managed en bloc through extra-sheath dissection of the first hepatic hilum—known as Glissonian pedicle transection hepatectomy. In 2017, Sugioka further systematized this approach by incorporating Laennec capsule anatomy, describing six fissures through which target pedicles could be isolated and transected during Glissonian pedicle hepatectomy. These fissures were termed the “Six Gates”. In recent years, our team has applied the “Six Gates” concept in clinical practice, achieving complete and systematic dissection of these six anatomical “Gates” to successfully perform laparoscopic Glissonian pedicle transection hepatectomy with favorable outcomes. Building on this foundation, we have expanded and refined Sugioka’s theory by introducing the “windows” concept for rapid “Gate” localization. Additionally, we identified and named two previously undefined major fissures in the first hepatic hilum: the “Seventh Gate” and the “Eighth Gate”, enabling intersegmental Glissonian pedicle dissection in these regions.
Key words
six gates /
anatomy /
glissonian pedicle /
laparoscopy /
hepatectomy
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