Surgical anatomy of liver

Surgical anatomy of liver.

1. Surgical anatomy of liver Ashish Tripathi, PGY3 Gen Surgery, RTIICS, Kolkata

2. A good knowledge of the anatomy is a prerequisite for modern surgery of the liver.” H. Bismuth

3. Topographic Anatomy Right Left Quadrate Caudate

4. Segmental Anatomy (Couinaud System) Caudate Lobe Segment I Left Lobe Segments II – IV Right Lobe Segments V-VIII

5. Segmental anatomy of the liver Rt .& Lt. lobes anatomically no morphological significance. Separation by ligaments (Falciform, lig. Venoosum & Lig.teres) True morphological and physiological division by a line extend from fossa of GD to fossa of I.V.C each has its own arterial blood supply, venous drainage and biliary drainage No anastomosis between divisions 3 major hepatic veins  Rt, Lt & central 8 segments based on hepatic and portal venous segments

6. Segmental anatomy of the liver Liver segments are based on the portal and hepatic venous segments

7. Bismuth’s classification: H. Bismuth brought together the Couinaud’s cadaveric system in situ and the system of Goldsmith and Woodburn in vivo. He distinguished three planes ( scissurae ), hosting the hepatic veins and a transverse plane passing through the right and left portal branches. Additionally, H. Bismuth described the caudate lobe as a separate segment I.

8. Portal Vein 75% of hepatic blood flow 1-3cm diameter 5-8cm length 4-5mm Hg

9. Portal Vein Laminar Blood flow Affects distribution of amebic abscesses and tumor metastases

10. Hepatic Artery Cautions Only 55-65% of population has “ normal ” hepatic arterial anatomy Aberrant R hepatic artery may be mistaken for cystic artery Cystic artery may originate from the gastroduodenal artery, the left hepatic artery, or the common hepatic artery

11. Source: HPB 2000; 2(3):333-39 Terminology Committee of the International Hepato-Pancreato-Biliary Association