Configuration of the right portion of the caudate lobe with special reference to identification of its right margin

Kitagawa, Shingo; Murakami, Gen; Hata, Fumitake; Hirata, Koichi

doi:10.1002/1098-2353(2000)13:5<321::aid-ca2>3.0.co;2-r

Cited by 31 publications

(35 citation statements)

References 27 publications

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“…In the present study, however, the term PV8c was limited to a medial or upward branch arising from the anterior sectorial trunk (a common stem of PV5 and PV8) or the proximal 20 mm of PV8. This narrow definition is useful in allowing easy differentiation from a PC of right portal vein origin (Kitagawa et al, 2000). Our PV8c seemed to correspond to "PV8 med" in Yamane et al (1988) and Ortale et al (2000) (PV8m in Fig.…”

Section: Introductionmentioning

confidence: 74%

“…The latter usually appeared as a curved line running from the ligamentum venosum to the right portal bifurcation (a dividing point of the anterior and posterior sectorial trunks). To allow precise cutting along these lines, we modified the sliding knife method used by Kitagawa et al (2000) by using metal guiding pins. In short, to guide the knife we inserted two metal pins from the external surface of the liver to and along a specific point on intrahepatic portal vein branches.…”

Section: Methodsmentioning

confidence: 99%

“…To identify the margins of the caudate lobe easily, Couinaud (1994) included marginal parts of S7 and S8 in the paracaval portion and divided the caudate lobe into S1 (left half) and S9 (right half). We consider Couinaud's definition oversimplified (Kitagawa et al, 2000), although parts of S7 and S8 are located "paracavally. "…”

Section: Introductionmentioning

confidence: 99%

“…Variations in the joining pattern of the MHV and the left hepatic vein (LHV), which are frequently observed (Masselot and Leborgne, 1978;Nakamura and Tsuzuki, 1981), may also cause difficulties when operating around the MHV. Moreover, to our knowledge, the anatomy of the ventral margin of the paracaval portion of the caudate lobe has not been investigated as systematically as that of the right margin, which was demarcated by Kitagawa et al (2000) according to their newly defined "right paracaval plane." Overall, the aim of this study is to clarify the morphologic characteristics of the ventral margin, i.e., its depth, location, and incidence, together with its topographic relationships with other segments of the liver and the hepatic veins, to determine the optimal techniques for operating in and around this area.…”

Section: Introductionmentioning

confidence: 99%

“…1). The paracaval portion, if it is large, is liable to include the dome-like area of parenchyma under the terminals not only of the RHV and MHV (Ishiyama et al, 1999;Ishiyama and Yamauchi, 2000), but also the LHV (Kitagawa et al, 2000). The parenchyma ventrally adjacent to the paracaval portion is thought to be supplied by a subsegmental portal vein to the medial subdivision of S8, PV8c, (Kumon, 1985) and usually the segmental portal vein to S4, PV4, including PV4dor (Takayasu et al, 1985) or PV4c Nishio et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Location of the ventral margin of the paracaval portion of the caudate lobe of the human liver with special reference to the configuration of hepatic portal vein branches

et al. 2002

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The topographic anatomy of the ventral margin of the paracaval portion of the caudate lobe of the human liver has not been clearly described to date. To this end we hypothesize the existence of a precaudate plane, a flat or slightly curved plane defined by the ventral margins of the ligamentum venosum and the hilar plate. Using 76 cadaveric livers, we investigated whether the paracaval portion of the caudate lobe extended ventral to this plane and whether the paracaval caudate branch of the portal vein (PC) ran through this plane to its ventral side. In 28 of the specimens (36.8%), the PC extended over the plane to a variable depth: less than 10 mm in 10 specimens, 10 -20 mm in 10, and more than 20 mm in eight specimens. This ventral extension of the PC consistently included its penetration into the dome-like area under the terminals of the three major hepatic veins; therefore, the ventrally extended PC often interdigitated with these veins and their tributaries (in practice, the ventral margin of the paracaval portion of the caudate lobe could generally be considered to run alongside the middle hepatic vein). Moreover, the ventral extension of the PC often reached the upper, diaphragmatic surface or the dorsal surface of the liver immediately to the right of the inferior vena cava. Several branches (termed border branches) in the ventral extension were difficult to identify as belonging to the PC. We discuss both the marginal configuration of the paracaval portion of the caudate lobe and how to identify and operate on the ventrally extended PC and related border branches during liver surgery. Clin. Anat. 15:387-401, 2002.

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Section: Introductionmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Location of the ventral margin of the paracaval portion of the caudate lobe of the human liver with special reference to the configuration of hepatic portal vein branches

et al. 2002

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How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver?

et al. 2003

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This study investigates the relevant anatomy for applying the hanging maneuver to hepatectomy by an anterior approach, where liver mobilization is not possible. Using 176 cadaveric livers, we morphometrically investigated the distribution of venous openings within the retrohepatic portion of the inferior vena cava (IVC); next, we conducted a series of experiments to identify which course for insertion of a pair of forceps preserved the thickest of these veins. After anterior dissection of the liver, we carried out an anterior incision along a plane within an area free of venous openings in the IVC. The area free of venous openings was between the thickest caudate vein and the inferior right hepatic vein (IRHV), and averaged 16.2 mm in width. When forceps were inserted along the rightward course connecting the right inferior angle of the right lobe and the same pocket-like space between the terminals of the middle and right hepatic veins, the caudate vein was very likely to be preserved, whereas the IRHV was not. In contrast, the leftward course connecting the gallbladder fossa and the pocket-like space provided an almost opposite incidence of damage. The portal territory of the hilar bifurcation was most likely to be damaged during a virtual incision along an avascular plane; however, the caudate branch of left portal origin was rarely damaged. The rightward course may be the best method for forceps insertion in cases where there is no IRHV. To preserve the caudate vein and the IRHV, taping on the right side of the IRHV and retracting to the right, or changing the direction of the forceps from leftward to rightward when the tip of the forceps is anterior to the IVC is recommended. The hanging maneuver by an anterior approach without mobilization is convenient for right or left hepatectomy for large tumors or hardened liver.

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Topographical anatomy of Spiegel's lobe and its adjacent organs in mid‐term fetuses: Its implication on the development of the lesser sac and adult morphology of the upper abdomen

et al. 2010

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At 8-16 weeks of gestation, Spiegel's lobe of the caudate lobe appears as a sac-like herniation of the liver parenchyma between the inferior vena cava and ductus venosus or Arantius' duct. In 5 of 11 fetuses at 20-30 weeks of gestation, we found that an external notch was formed into the posterior aspect of the caudate lobe by a peritoneal fold containing the left gastric artery. This notch appeared to correspond to that observed in adults, which is usually seen at the antero-inferior margin of the lobe after rotation of the lobe along the horizontal or transverse axis. However, the notch did not accompany two of the three fetuses in which the left hepatic artery originated from the left gastric artery. Notably, until 9-10 weeks of gestation, the inferior and left part of Spiegel's lobe rode over the hepatoduodenal ligament and protruded medially into the lesser sac (bursa omentalis) behind the stomach. Thus, the fetal Winslow's foramen was located at the "superior" side of the ligament. However, as seen in adults, the protruding Spiegel's lobe was located at the posterior side of the lesser omentum. Therefore, a hypothetical rotation along the transverse axis in the later stages of development seems necessary to explain this repositioning. Considering that Spiegel's lobe develops faster than surrounding structures, it is likely that the lesser sac resulting from the rotation of the gastrointestinal tract, which actively contributes to facilitate the growth of the Spiegel lobe.

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Configuration of the right portion of the caudate lobe with special reference to identification of its right margin

Cited by 31 publications

References 27 publications

Location of the ventral margin of the paracaval portion of the caudate lobe of the human liver with special reference to the configuration of hepatic portal vein branches

Location of the ventral margin of the paracaval portion of the caudate lobe of the human liver with special reference to the configuration of hepatic portal vein branches

How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver?

Topographical anatomy of Spiegel's lobe and its adjacent organs in mid‐term fetuses: Its implication on the development of the lesser sac and adult morphology of the upper abdomen

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