Expert consensus on Laennec capsule guided hepatobiliary surgery (2026 edition)

doi:10.3877/cma.j.issn.2095-3232.2026.03.001

Abstract

Abstract:

The Laennec capsule is an intrinsic fibrous connective tissue covering the intrahepatic and extrahepatic parenchyma. The Chinese Chapter of the International Hepato‐Pancreato‐Biliary Association organized domestic experts in this field to formulate the Expert consensus on Laennec capsule guided hepatobiliary surgery (2026 edition). Based on evidence‐based medicine principles, the consensus systematically summarizes the anatomical definition of Laennec capsule and its applications in hepatobiliary surgery, clarifies the anatomical spaces between Laennec capsule and Glisson sheath, hepatic veins, and inferior vena cava, and proposes the Laennec capsule guided surgical approach, aiming to standardize surgical procedures,improve surgical safety and efficacy, promote the popularization and stardardization of surgical plans, outline future directions in researches.

Key words: Liver diseases, Laennec capsule, Anatomic hepatectomy, Laennec approach, Laparoscopy, Consensus

Chinese Chapter of the International Hepato-Pancreato-Biliary Association. Expert consensus on Laennec capsule guided hepatobiliary surgery (2026 edition)[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 281-289.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2026.03.001

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2026/V15/I03/281

References 61

[1]	Couinaud C, Peres C. La résection de la dernière anse grêle est‐elle une intervention dangereuse? Faut‐il la rejeter au profit de l′hémicolectomie droite? Réflexions à propos de 5 cas [Is resection of the last small intestinal loop a hazardous intervention? Is it necessary to set aside the benefit of right hemicolectomy? Reflections on 5 cases[J]. J Chir (Paris), 1957, 73(5): 461-469.
[2]	Hayashi S, Murakami G, Ohtsuka A, et al. Connective tissue configuration in the human liver hilar region with special reference to the liver capsule and vascular sheath[J]. J Hepatobiliary Pancreat Surg, 2008, 15(6): 640-647. DOI: 10.1007/s00534‐008‐1336‐8.
[3]	Sugioka A, Kato Y, Tanahashi Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec′s capsule: proposal of a novel comprehensive surgical anatomy of the liver[J]. J Hepatobiliary Pancreat Sci, 2017, 24(1): 17-23. DOI: 10.1002/jhbp.410.
[4]	Hu Y, Shi J, Wang S, et al. Laennec′s approach for laparoscopic anatomic hepatectomy based on Laennec′s capsule[J]. BMC Gastroenterol, 2019, 19(1): 194. DOI: 10.1186/s12 876‐019‐1107‐9.
[5]	Yu D, Xia L. Progress on Laennec′s capsule guidance for hepatobiliary surgery[J]. ILIVER, 2025, 4(3): 100183. DOI: 10.1016/j.iliver.2025.100183.
[6]	Hu W, Zhang G, Chen M, et al. Laennec′s approach for laparoscopic anatomical hemihepatectomy[J]. World J Surg Oncol, 2021, 19(1): 295. DOI: 10.1186/s12957‐021‐02404‐1.
[7]	Li B, Yin D, Zhang Q, et al. Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: a multicenter cohort study[J]. Int J Surg, 2025, 111(2): 1929-1938. DOI: 10.1097/JS9.0000000000002212.
[8]	张志恒, 张来柱, 彭进, 等. Laennec入路腹腔镜胆囊切除术治疗 Mirrizi 综合征Ⅱ型[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(3): 190-192. DOI: 10.3877/cma.j.issn.1674-6899.2023.03.014.
[9]	Ouyang B, Zhang L, Cao Y, et al. Laparoscopic cholecystectomy based on Laennec approach via the cystic plate with lymphadenectomy in Calot′s triangle for gallbladder neoplasms: initial experience and technical details[J]. ILIVER, 2023, 2(4): 202-207. DOI: 10.1016/j.iliver.2023.10.001.
[10]	陈政, 曹亚娟, 王飞, 等. 去蒂法腹腔镜解剖性肝切除在肝胆管结石肝切除术中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(1): 15-18. DOI: 10.3877/cma.j.issn.1674-6899.2025.01.003.
[11]	Shirata C, Kokudo T, Gillet M, et al. Reappraisal of Laennec′s capsule[J]. Surg Oncol, 2020, 33: 222-223. DOI: 10.1016/j.suronc.2019.08.004.
[12]	Monden K, Ohno K, Hayashi S, et al. Hepatic vein anatomy related to Laennec′s capsule for liver resection[J]. J Hepatobiliary Pancreat Sci, 2023, 30(5): 551-557. DOI: 10.1002/jhbp.1250.
[13]	Shirata C, Hasegawa K, Halkic N, et al. Laennec′s capsule does not exist around the peripheral hepatic veins[J]. J Hepatobiliary Pancreat Sci, 2019, 26(10): E13. DOI: 10.1002/jhbp.658.
[14]	Zhang Y, Shi N, Zou Y, et al. The characteristics of Laennec′s capsule around the hepatic veins: a histological study based on 71 liver surgical specimens[J]. Ann Gastroenterol Surg, 2023, 7(2): 287-294. DOI: 10.1002/ags3.12618.
[15]	Cabibi D, Bronte F, Porcasi R, et al. Comparison of histochemical stainings in evaluation of liver fibrosis and correlation with transient elastography in chronic hepatitis[J]. Anal Cell Pathol (Amst), 2015, 2015: 431750. DOI: 10.1155/2015/431750.
[16]	Kiguchi G, Sugioka A, Kato Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi‐prone position[J]. Surg Oncol, 2019, 29: 140-141. DOI: 10.1016/j.suronc.2019.05.001.
[17]	Zheng K, He D, Liao A, et al. Laparoscopic segmentectomy Ⅳ using hepatic round ligament approach combined with fluorescent negative staining method[J]. Ann Surg Oncol, 2022, 29(5): 2980-2981. DOI: 10.1245/s10434-021-11221‐5.
[18]	Zheng K, Liao A, Yan L, et al. Laparoscopic anatomic bisegmentectomy (S3 and S4b) using the Glisson′s pedicle-first and intrahepatic anatomic markers approach[J]. Surg Endosc, 2022, 36(10): 7859-7860. DOI: 10.1007/s00464-022-09448‐8.
[19]	Cho SC, Kim JH. Laparoscopic left hemihepatectomy using the extrahepatic Glissonean approach: technical tips for entering gaps[J]. J Surg Oncol, 2022, 126(8): 1430-1433. DOI: 10.1002/jso.27086.
[20]	Lee MJ, Kim JH, Jang JH. Tailored strategy for dissecting the Glissonean pedicle in laparoscopic right posterior sectionectomy: extrahepatic, intrahepatic, and transfissural Glissonean approaches (with video)[J]. World J Surg, 2022, 46(8): 1962-1968. DOI: 10.1007/s00268‐022‐06574‐1.
[21]	曹亚娟, 张来柱, 余德才. 新辅助联合机器人右半肝切除治疗进展期肝癌: Laennec 入路联合背侧入路[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(2): 115-116. DOI: 10.3877/cma.j.issn.1674‐6899.2022.02.011.
[22]	胡雄伟, 雷光林, 王森, 等. Laennec膜入路机器人肝右前叶(S5/8段)切除术[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(6): 604. DOI: 10.3877/cma.j.issn.1674-3946.2022.06.006.
[23]	王文儿, 周国超, 田潭平, 等. 循Laennec膜优先横断左肝蒂联合头背侧入路腹腔镜左半肝切除术(附视频)[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(4): 401-405. DOI: 10.3877/cma.j.issn.2095-3232.2022.04.015.
[24]	Lai J, Wu J, Bai Y, et al. A novel Laennec′s capsule tunnel approach for pure laparoscopic left hemihepatectomy: a propensity score matching study[J]. Front Surg, 2023, 10: 1136908. DOI: 10.3389/fsurg.2023.1136908.
[25]	Morimoto M, Matsuo Y, Nonoyama K, et al. Glissonean pedicle isolation focusing on the Laennec′s capsule for minimally invasive anatomical liver resection[J]. J Pers Med, 2023, 13(7): 1154. DOI: 10.3390/jpm13071154.
[26]	段键, 何金兰, 孟祥宇, 等. Laennec膜解剖在结直肠癌肝转移手术中的应用[J]. 重庆医学, 2023, 52(8): 1147-1150. DOI: 10.3969/j.issn.1671-8348.2023.08.006.
[27]	陆昌友, 徐云柯, 郑瑗, 等. Laennec膜与模式化入路腹腔镜肝左外叶切除的临床对比研究[J]. 中华肝胆外科杂志, 2023, 29(1): 49-53. DOI: 10.3760/cma.j.cn113884-20220530-00227.
[28]	林治宇, 夏鑫, 雷寰, 等. 基于Laennec膜的肝蒂CT三维重建及肝蒂鞘外分离阻闭钳的研发与验证[J]. 临床肝胆病杂志, 2025, 41(10): 2118-2124. DOI: 10.12449/JCH251023.
[29]	王新团, 李博, 李栋, 等. Laennec膜入路与Glisson鞘入路在腹腔镜解剖性肝切除中的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(4): 418-422. DOI: 10.3877/cma.j.issn.1674-3946.2023.04.018.
[30]	郑颖, 俞世安, 李仓, 等. 三维可视化下Laennec入路联合术中超声在腹腔镜右半肝段精准切除术中的应用[J]. 中华普通外科杂志, 2023, 38(3): 207-209. DOI: 10.3760/cma.j.cn113855‐20220627‐00417.
[31]	Yang Y, Yu CY, Lin F, et al. Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy[J]. ANZ J Surg, 2024, 94(4): 655-659. DOI: 10.1111/ans.18907.
[32]	陈鹏宇, 罗宗将, 陈益晨, 等. 基于Laennec膜理论Glisson鞘外阻断法腹腔镜左半肝切除术的临床研究[J]. 中华普通外科杂志, 2021, 36(10): 795-796. DOI: 10.3760/cma.j.cn113855‐20201207‐00915.
[33]	胡森焱, 徐冬, 方健, 等. ICG荧光显影Laennec膜入路腹腔镜解剖性肝切除的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(5): 513-516. DOI: 10.3877/cma.j.issn.1674‐3946.2024.05.012.
[34]	刘连新, 张树庚. 腹腔镜左半肝联合左尾状叶切除术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(4): 368. DOI: 10.3877/cma.j.issn.1674‐3946.2024.04.005.
[35]	王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(1): 37-40. DOI: 10.3877/cma.j.issn.1674-3946.2024.01.011.
[36]	周后平, 欧廷政, 尚明铭, 等. Laennec膜入路Glisson鞘外阻断联合ICG荧光影像在解剖性肝切除术中的应用(附视频)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(1): 57-61. DOI: 10.3877/cma.j.issn.2095‐3232.2024.01.011.
[37]	朱楠, 沈锋. 腹腔镜半肝切除术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(4): 367. DOI: 10.3877/cma.j.issn.1674-3946.2024.04.004.
[38]	张文君, 陈晓鹏. Laennec膜及其在腹腔镜肝胆外科手术中的应用[J]. 肝胆胰外科杂志, 2024, 36(5): 257-261, 268. DOI: 10.11952/j.issn.1007‐1954.2024.05.001.
[39]	俞远林, 彭俊璐, 陈晓鹏. 肝胆管结石病腹腔镜解剖性肝切除术中肝蒂及肝断面的处理[J]. 肝胆胰外科杂志, 2024, 36(6): 321-325. DOI: 10.11952/j.issn.1007-1954.2024.06.001.
[40]	Kiguchi G, Sugioka A, Kato Y, et al. Laparoscopic S7 Segmentectomy using the inter‐Laennec approach for hepatocellular carcinoma near the right hepatic vein[J]. Surg Oncol, 2019, 31: 132-134. DOI: 10.1016/j.suronc.2019.10.008.
[41]	Monden K, Sadamori H, Hioki M, et al. Laparoscopic anatomic segmentectomy 8 using the outer‐Laennec approach[J]. Surg Oncol, 2020, 35: 299-300. DOI: 10.1016/j.suronc.2020.08.029.
[42]	张传海, 周毅, 方雨, 等. 基于"红/黄交界线"的 Laennec膜入路腹腔镜第二肝门解剖法[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(5): 738. DOI: 10.3877/cma.j.issn.2095-3232.2024.05.026.
[43]	Hanzawa S, Monden K, Hioki M, et al. How‐I‐do‐it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec′s capsule[J]. Langenbecks Arch Surg, 2021, 406(6): 2091-2097. DOI: 10.1007/s00423‐021‐02282‐x.
[44]	Nakano Y, Abe Y, Kitago M, et al. Extrahepatic approach for taping the common trunk of the middle and left hepatic veins or the left hepatic vein alone in laparoscopic hepatectomy (with videos)[J]. J Hepatobiliary Pancreat Sci, 2023, 30(2): 192-201. DOI: 10.1002/jhbp.1212.
[45]	Wang X, Li J, Cao J, et al. Approaches of laparoscopic anatomical liver resection of segment 8 for hepatocellular carcinoma: a retrospective cohort study of short‐term results at multiple centers in China[J]. Int J Surg, 2023, 109(11): 3365-3374. DOI: 10.1097/JS9.0000000000000608.
[46]	Zhang C, Ma J, Zhou Y. Laparoscopic dissection of the first and second porta hepatis along Laennec′s capsule via "Hepatic Serosal Incision" approach: how I do it[J]. World J Surg, 2024, 48(8): 1967-1972. DOI: 10.1002/wjs.12255.
[47]	Monden K, Sugioka A, Hioki M, et al. The inter‐laennec approach for liver tumors in contact with hepatic veins in laparoscopic liver resection[J]. Ann Surg Oncol, 2024, 31(12): 7890-7891. DOI: 10.1245/s10434‐024‐15844‐2.
[48]	Blanco Asensio N, Aliseda Jover D, Martí‐Cruchaga P, et al. Anatomical left hepatectomy extended to caudate lobe due to colorectal metastasis with intrabiliary growth: securing optimal margins with a Laennec′s capsule approach and vein‐guided resection[J]. Ann Surg Oncol, 2024, 31(7): 4447-4448. DOI: 10.1245/s10434‐024‐15174‐3.
[49]	余德才. 肝脏膜性解剖及Laennec入路解剖性肝切除[J/OL]. 中华腔镜外科杂志(电子版), 2019, 12(6): 332-336. DOI: 10.3877/cma.j.issn.1674‐6899.2019.06.005.
[50]	金建光. Laennec膜在肝脏外科中的研究进展[J]. 中华肝胆外科杂志, 2022, 28(2): 151-153. DOI: 10.3760/cma.j.cn11 3884‐20210928‐00321.
[51]	中国研究型医院学会肝胆胰外科专业委员会, 《中华消化外科杂志》编辑委员会. 腹腔镜解剖性肝切除手术操作流程及技术标准中国专家共识(2023版)[J]. 中华消化外科杂志, 2023, 22(7): 810-823. DOI: 10.3760/cma.j.cn115610-2023 0714-00410.
[52]	彭进, 岳扬, 余德才. 基于Laennec膜指引多次肝脏手术后肝周粘连分离[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(4): 243-245. DOI: 10.3877/cma.j.issn.1674-6899.2023.04.009.
[53]	Umemura A, Nitta H, Takahara T, et al. Identifying cystic vein perfusion area employing indocyanine green fluorescence imaging during laparoscopic extended cholecystectomy for clinical T2 gallbladder cancer[J]. Case Rep Gastroenterol, 2020, 14(1): 110-115. DOI: 10.1159/00050 6361.
[54]	Ome Y, Hashida K, Yokota M, et al. Laparoscopic approach to suspected T1 and T2 gallbladder carcinoma[J]. World J Gastroenterol, 2017, 23(14): 2556-2565. DOI: 10.3748/wjg.v23.i14.2556.
[55]	Tokumitsu Y, Shindo Y, Matsui H, et al. Laparoscopic total biopsy for suspected gallbladder cancer: a case series[J]. Health Sci Rep, 2020, 3(2): e156. DOI: 10.1002/hsr2.156.
[56]	陈东杰, 许明辉, 单强, 等. 膜解剖的腹腔镜下胆囊全层切除术治疗胆囊局灶性病变的安全性分析[J]. 肝胆胰外科杂志, 2023, 35(8): 475-478. DOI: 10.11952/j.issn.1007-1954.2023.08.006.
[57]	王鹏, 马乐, 周亚军, 等. 基于Laennec膜的完全胆囊切除术在胆囊息肉手术中的应用[J]. 中国微创外科杂志, 2023, 23(10): 746-752. DOI: 10.3969/j.issn.1009-6604.2023.10.006.
[58]	袁源. 胆囊板Laennec膜间隙逆行分离联合Pringle法在困难胆囊腹腔镜切除术中应用[D]. 吉首: 吉首大学, 2023.
[59]	周后平, 袁源, 欧廷政, 等. 胆囊板Laennec 膜间隙逆行分离联合Pringle法在困难胆囊LC术中应用(附视频)[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(5): 540-544. DOI: 10.3877/cma.j.issn.2095‐3232.2023.05.013.
[60]	殷晓煜. 如何提高肝胆管结石手术治疗效果[J]. 肝胆外科杂志, 2019, 27(3): 167-170. DOI: 10.3969/j.issn.1006-4761.2019.03.004.
[61]	纪任, 朱洪涛, 洪晓明, 等. 沿肝中静脉解剖性半肝切除治疗区域型肝胆管结石34例[J]. 中华肝胆外科杂志, 2019, 25(4): 295-297. DOI: 10.3760/cma.j.issn.1007-8118.2019.04.13.

Please choose a citation manager

Content to export