The Intersegmental Plane of the Liver Is Not Always Flat—Tricks for Anatomical Liver Resection

Abstract

The intersegmental plane of the liver has an uneven and curved surface, especially in the right and left portal scissurae. The identification and exposure of the landmark vein on the cut surface is an important technique for avoiding disorientation during anatomic liver resection.

Perfusion and drainage difference in the liver parenchyma: Regional plane in segment 6

“…Transection of the liver parenchyma along with the major hepatic vein is considered to be one of the goldstandard methods for anatomic liver resection (6,7). However, present study revealed that the 41.7% was failed to remove entire perfusion area in S6 when the patients was performed based on the hepatic-vein-based anatomy.…”

“…However, few reports have so far focused on this essential issue in anatomic liver resection (7,8). We investigate which anatomic factors influenced to such differences and how much parenchymal volume was different between the perfusion areas and drainage area of the liver parenchyma.…”

Clinical Anatomy of the Liver: Review of the 19th Meeting of the Japanese Research Society of Clinical Anatomy

“…Anatomical resection of segment 8 (S8) consists of 28% of all the other segmentectomies, which shows that S8 is the most popular segment that is resected. S8 accounts for 24.2% of the entire liver volume, which is the largest segment [15] . During anatomical resection of S8, the ventral and dorsal glissonean branches of segment 8 are divided, and the MHV and RHV are exposed on the transactional plane as the landmark veins.…”

Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation

“…This watershed zone is always clearly observable in segment VIII, as described in our previous work. 5 However, the drainage pattern of the caudal part of the right paramedian sector (i.e., segment V region) varies among individuals, with V5 occasionally extending to the right lateral sector and draining a proportion of segment VI (n = 8, 8%). Approximately half of the right paramedian sector is drained by MHV (mean proportion, 56.1%), including the drainage region of V8i (mean proportion, 15.6%), with the remaining part drained by RHV (mean proportion, 43.9%).…”

“…This precise visualization of the hepatic vascular territories has provided new insights into the surgical anatomy of the liver. 5 The 3D liver analysis is widely used as a component of preoperative work-up for liver resection and transplantation. However, despite recent technical innovations in imaging studies, unexpected intraoperative decision-making is frequently required during complex hepatobiliary surgery and knowledge of the surgical anatomy of the liver remains crucial in such situations.…”