Terminology of liver anatomy and resections.pptx

terminology of hepatic resections.. couinaud's and brisbane 2000 terminology.

1. Terminology of Liver Anatomy and Resections Dr Karrar Adil

2. INTRODUCTION : The liver is the largest organ in the body, weighing 1.7 kg in the average 80-kg man. It sits in the right upper quadrant beneath the diaphragm, and is protected by the rib cage. The liver parenchyma is entirely covered by a thin capsule ( Glisson’s capsule ) and by visceral peritoneum on all but the posterior surface of the liver, termed the ‘bare area’. it is divided into a large right lobe, which constitutes three-quarters of the liver volume, and a smaller left lobe.

3. ANATOMY OF THE LIVER : Understanding the segmental anatomy of the liver has greatly facilitated safe liver surgery. Couinaud , a French surgeon, described the liver as being divided into 8 segments. Each one of these segments can be considered as a functional unit, with a branch of hepatic artery, portal vein, and bile duct, and drained by a branch of the hepatic vein. The overall anatomy of the liver is divided into a functional right and left portions by a vertical plane extends from the inferior vena cava posteriorly to the middle of the gallbladder fossa anteriorly ( line of Cantlie ).

4. Each of these major right and left portions of the liver is divided into sectors and segments depending on the distribution of hepatic veins and portal structures. Liver segments ( Il – IV) lie to the left of the line of Cantlie , functionally, is the left liver, which is supplied by the left branch of the hepatic artery and the left branch of portal vein and drains bile via the left hepatic duct . Liver segments (V – VIII) lie to the right of the line of Cantlie , functionally, is the right liver, which is supplied by the right branch of the hepatic artery and the right branch of portal vein and drains bile via the right hepatic duct.

5. Couinaud Classification

6. Couinaud terminology for liver resections 1957 : Right hepatectomy : involves segment V, VI, VII, VIII resection. Extended right hepatectomy (right lobectomy ) : involves segment IV,V , VI, VII, VIII ± I resection. Left hepatectomy : involves segment II, III, IV resection. Extended left hepatectomy : involves segment II, III, IV, V, VIII ± I resection . Left lobectomy (left lateral segmentectomy ) : involves segment II & III resection .

7. The Brisbane 2000 Terminology of Liver Anatomy and Resections

8. First order division :

9. Second order division :

10. Third order division :

11. Thank you …