Technical advances and application strategies in anatomical hepatic resection based on Laennec's capsule

Laennec's capsule is a dense fibrous membrane that has recently been confirmed to exist across the entire liver surface, Glissonean pedicles, and major hepatic veins, forming a continuous fibrous system. Minimally invasive anatomical liver resection based on Laennec's capsule-guided dissection leverages natural avascular planes to enable safe and efficient resection. This approach significantly reduces intraoperative bleeding, improves surgical precision and R0 resection rates, and contributes to better long-term survival in patients. This review discusses the anatomical concept of Laennec's capsule and its clinical application in minimally invasive anatomical liver resection. It outlines the advantages, limitations, and strategic use of various preoperative navigation techniques; analyses the indications for intrafascial/extrafascial Glissonean approaches and the technical aspects of their selection; analyses outer/inner dissection of Laennec's capsule around the hepatic veins according to the type of tumour; and proposes technical refinements based on outflow control and precision surgery. Finally, it explores the debate about the origins of Laennec's capsule and suggests directions for future bastardization and research. This review aims to provide hepatobiliary surgeons with a comprehensive reference based on recent technical advances and application strategies for Laennec's capsule-based anatomical liver resection.