Structure and surgical dissection layers of the bare area of the liver
Abstract Background The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological stu...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-07-01
|
Series: | BMC Surgery |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12893-020-00830-8 |
id |
doaj-4c584e92234b43bfb96dff52e6abdad9 |
---|---|
record_format |
Article |
spelling |
doaj-4c584e92234b43bfb96dff52e6abdad92020-11-25T02:54:20ZengBMCBMC Surgery1471-24822020-07-012011810.1186/s12893-020-00830-8Structure and surgical dissection layers of the bare area of the liverTakamichi Ishii0Satoru Seo1Takashi Ito2Satoshi Ogiso3Ken Fukumitsu4Kojiro Taura5Toshimi Kaido6Shinji Uemoto7Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityAbstract Background The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. Methods Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. Results The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. Conclusions Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.http://link.springer.com/article/10.1186/s12893-020-00830-8Bare areaLiverDiaphragmCadaverLaennec’s capsule |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Takamichi Ishii Satoru Seo Takashi Ito Satoshi Ogiso Ken Fukumitsu Kojiro Taura Toshimi Kaido Shinji Uemoto |
spellingShingle |
Takamichi Ishii Satoru Seo Takashi Ito Satoshi Ogiso Ken Fukumitsu Kojiro Taura Toshimi Kaido Shinji Uemoto Structure and surgical dissection layers of the bare area of the liver BMC Surgery Bare area Liver Diaphragm Cadaver Laennec’s capsule |
author_facet |
Takamichi Ishii Satoru Seo Takashi Ito Satoshi Ogiso Ken Fukumitsu Kojiro Taura Toshimi Kaido Shinji Uemoto |
author_sort |
Takamichi Ishii |
title |
Structure and surgical dissection layers of the bare area of the liver |
title_short |
Structure and surgical dissection layers of the bare area of the liver |
title_full |
Structure and surgical dissection layers of the bare area of the liver |
title_fullStr |
Structure and surgical dissection layers of the bare area of the liver |
title_full_unstemmed |
Structure and surgical dissection layers of the bare area of the liver |
title_sort |
structure and surgical dissection layers of the bare area of the liver |
publisher |
BMC |
series |
BMC Surgery |
issn |
1471-2482 |
publishDate |
2020-07-01 |
description |
Abstract Background The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. Methods Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. Results The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. Conclusions Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin. |
topic |
Bare area Liver Diaphragm Cadaver Laennec’s capsule |
url |
http://link.springer.com/article/10.1186/s12893-020-00830-8 |
work_keys_str_mv |
AT takamichiishii structureandsurgicaldissectionlayersofthebareareaoftheliver AT satoruseo structureandsurgicaldissectionlayersofthebareareaoftheliver AT takashiito structureandsurgicaldissectionlayersofthebareareaoftheliver AT satoshiogiso structureandsurgicaldissectionlayersofthebareareaoftheliver AT kenfukumitsu structureandsurgicaldissectionlayersofthebareareaoftheliver AT kojirotaura structureandsurgicaldissectionlayersofthebareareaoftheliver AT toshimikaido structureandsurgicaldissectionlayersofthebareareaoftheliver AT shinjiuemoto structureandsurgicaldissectionlayersofthebareareaoftheliver |
_version_ |
1724721885126590464 |