Lecture : Hepatectomy is comprised of many steps of techniques. It is very difficult to discuss the superiority among various techniques of hepatectomy. In the evaluation of the superiority of hepatectomy techniques, the expertise and familiarity of the liver surgeons of each medical institution as well as the advantages of each techniques are critical. However, the most ideal hepatectomy techniques that is considered to be common among all surgeons are first, all types of hepatectomy must be systematically and universally applicable; second, the technique must be an effective so that the goal of the surgery is adequately accomplished; third, the procedure should be simple and easy; and last, the surgery must be performed safely despite anatomical variation Couinaud stated that there are three approaches to the systematic hepatectomy technique. The first is the classical approach splitting the hepatic artery, portal vein and bile duct through the hilus. Then the each corresponding branches for the intended hepatectomy are confirmed, ligated, and divided, after which the stained liver parenchyme is excised. The second approach is the extrafascial approach, outside the Glisson sheath, in which hilar portal pedicle is detached from the hilar plate. And then pulling the Glisson pedicle to the inferior and contralateral direction, the 1st order and 2nd order branches can be identified. And then corresponding Glisson pedicle branches for the expected hepatectomy are confirmed and ligated, followed by removal of the stained liver. The third approach is opening the plane of the portal fissure, approaching through the fissure. Since the anterior liver is thin and thus easily exposed, the hepatotomy requires a little efforts, followed by confirmation, ligation and division of the corresponding Glisson pedicle branches for the intended hepatectomy. I used to utilize a complimentary approach of the above three methods according to the specific diseases or requirements. Today, I am going to discuss one of the hepatectomy techniques, focusing on the transfissural approach among glissonean pedicle approaches. In primary liver cancer patients, the extrafascial approach or transfissural approach is utilized. After the corresponding branches of the Glisson pedicle of the expected hepatectomy are confirmed and ligated, the stained liver parenchyme is resected. For hepatectomy in patients with Klatskin tumors or in donor and recipient of liver transplantation, the classical approach through the hilus is preferred, which consists of confirmation, ligation and division of the hepatic artery, portal vein and bile duct, respectively, followed by resection of the stained liver parenchyme. Advantages of the glissonean pedicle approach in hepatectomy for hepatoma are that first, limited liver resection such as one segment resection is also permitted to systematic resection. Second, in hepatoma patients with accompanying liver cirrhosis, the portal venous collaterals or the engorged lymphatics within the Glisson sheath of the hepatic hilus are not disturbed during hepatectomy, which leads to minimizing of postoperative complications such as ascites. The third, even if an anatomical variation of the vascular pedicle of the liver is present during hepatectomy, complications such as inadequate injury of the vascular structures are also minimized. If a hilar plate and umbilical plate is employed during the glissonean pedicle approach, the exposure of the Glisson pedicle is relatively facilitated, and the extrafascial approach is usually adequate for the resection of right and left liver or segment 2, 3, 4, 2+3 or 3+4b. However, it is not always possible in right side hepatectomies due to intrahepatic anatomical variations. Therefore, my main technique employed is hepatotomy through the anterior liver for the openings of the main portal fissure, umbilical fissure, and right portal fissure, followed by the glissonean pedicle approach within the liver. This method allows direct intraoperative identification of the many branches of the Glisson pedicle, which permits easy and accurate systematic hepatectomy by the operator. Post-procedural liver function tests such as liver enzymes and total bilirubin levels after successful systematic liver resection are almost within the near-normal range. In contrast, non-anatomical resection such as enucleation or wedge resection results in long term abnormal liver function test. This is probably due to a remnant liver with an injured vascular pedicle. As described previously for systematic hepatectomy, there are various approaches for identifying the vascular pedicles. The evaluation of the superiority among these techniques is not desirable, because operator's choice and familiarity are very important factors in the treatment results of liver resection. If the reserved power of each individual medical institution permits, the technique that is simple, safe, and objective should be pursued. Recently, it is possible for us to use preoperatively 3D-image of the liver. Therefore, I think we should persue "tailored hepatectomy technique" according to intrahepatic anatomical variation as well as liver functional reserve.