Abstract
<title>Abstract</title> <p>Objective Laparoscopic anatomical liver segmentectomy (LALS) remains technically challenging due to the anatomical complexity of segmental Glissonean pedicles and the discrepancy between traditional ventral anatomical frameworks and the caudal laparoscopic view. This study aimed to establish a reproducible, caudal-based anatomical reference system for segmental Glissonean pedicles using Laennec's capsule as a guiding landmark, integrating cadaveric dissection, morphometric analysis, CT imaging, and three-dimensional (3D) reconstruction. Methods Six formalin-fixed adult human liver specimens were systematically dissected under the guidance of Laennec's capsule. Segmental Glissonean pedicles (segments I–VIII) were sequentially isolated from the hepatic hilum. Morphometric measurements were performed from a caudal perspective to simulate the laparoscopic view. Four anatomical landmarks (Points A–D) were defined: Point A (right margin of the inferior vena cava at the hepatic base), Point B (intersection of a vertical line from Point A with the right hepatic pedicle), Point C (bifurcation of segments VI–VII pedicles), and Point D (bifurcation of segments V–VIII pedicles). Two distance parameters (BC, BD) and four angular parameters (angles a–d) were quantified. Preoperative CT imaging and 3D reconstructions were correlated with cadaveric findings to validate clinical applicability. Results Systematic dissection revealed that left hepatic pedicles (segments II and III) demonstrated the highest anatomical consistency, whereas right hepatic pedicles exhibited substantial interindividual variability. Segment IV pedicles showed 2–5 branching patterns; segment V often received accessory inflow from segment VI; and segment VII demonstrated variable origins, including absence of an independent branch in some specimens. Quantitative analysis showed mean BC distance of 2.2 cm and BD distance of 2.9 cm, with BD consistently longer. Angle d averaged approximately 90°, indicating stable segment VIII orientation, whereas angle c varied widely (35°–131°), reflecting significant individual differences in posterior pedicle trajectories. 3D reconstructions successfully visualized these anatomical variants, including accessory inflow and atypical pedicle origins, enabling individualized preoperative surgical mapping. Conclusions The integration of Laennec's capsule-guided dissection, caudal-view morphometric parameters, and 3D reconstruction provides a novel and reproducible anatomical framework for laparoscopic navigation of segmental Glissonean pedicles. The quantitative landmarks (BC, BD, angles a–d) offer precise intraoperative guidance, particularly for the anatomically variable right liver, potentially enhancing the safety, precision, and standardization of laparoscopic anatomical liver segmentectomy.</p>