The importance of Glisson's capsule and its sheaths in the intrahepatic approach to resection of the liver.

Glisson's capsule extends into the liver as sheaths around the hepatic ducts, hepatic arteries and portal tributaries. Within the hepatic substance, these structures need not be dissected individually, but the sheath can be ligated "en masse." These sheaths can be approached either anteriorly (after division of the main fissure or right fissure or umbilical fissure) or posteriorly from behind the porta hepatis. We recently used these approaches in 70 patients during a 27 month period. The median blood loss was zero units and there was one postoperative death. We believe the technique adds precision and safety to surgical treatment of the liver.