SURGICAL ANATOMY OF THE LIVER BY DR IBRAHIM GALAL PROF OF SURGERY, CAIRO UNIVERSITY, EGYPT

IMPORTANCE OF SURGICAL (SEGMENTAL) ANATOMY OF THE LIVER PRESERVATION OF PRECIOUS LIVER TISSUE DURING: A- SURGERY. B- CHEMOTHERAPY. C- RADIOTHERAPY.

LIVER SURGERY A- BILOBAR METS. B- RESECTION IN CIRRHOTICS. C- SPLIT LIVER TRANSPLANTATION. D- LIVING DONOR TRANSPLANTATION.

REGIONAL CHEMOTHERAPY A- CONVENTIONAL. B- TRANSARTERIAL CHEMOEMBOLIZATION(TACE): HEPATIC ARTERY EMBOLIZATION BY DRUG- ELUTING BEADS(DEBs). (GELATIN SPONGE/LIPIDOL)

RADIOTHERAPY A- CONVENTIONAL. B- RADIOEMBOLIZATION: HEPATIC ARTERY EMBOLIZATION BY BEADS FILLED WITH RADIOACTIVE ISOTOPE. (YTTRIUM Y-90)

SURGICAL ANATOMY OF THE LIVER COUINAUD CLASSIFICATION (كوينو) THE LIVER IS DIVIDED BY THE PORTAL AND HEPATIC VEINS INTO EIGHT SEGMENTS. EACH SEGMENT HAS ITS OWN VASCULAR INFLOW, OUTFLOW AND BILIARY DRAINAGE.

RHV LHV MHV LPV RPV MPV IVC

THE PLANE OF MIDDLE HEPATIC VEIN DIVIDES THE LIVER INTO RIGHT AND LEFT LOBES (OR RIGHT AND LEFT HEMI LIVERS). THIS PLANE RUNS FROM THE INFERIOR VENA CAVA TO THE GALLBLADDER FOSSA(CANTLIE’s LINE). JAMES CANTLIE, 1926

CANTLIE’S LINE

CANTLIE’S LINE RT HEMI LIVER LT HEMI LIVER

HEPATIC VEINS (CORONAL CUT)

TOP VIEW RT HEMI LIVER MHV LT HEMI LIVER

TOP VIEW RHV RT HEMI LIVER MHV

TOP VIEW RPS RHV MHV RAS

TOP VIEW MHV LHV LT HEMI LIVER

TOP VIEW MHV LHV LMS LLS

SECTORS (TOP) RPS RAS LLS LMS

SECTORS (BOTTOM) LMS LLS RAS RPS

HEPATIC VEINS (AXIAL CUT) MHV LHV RHV IVC CT (L/MHVs)

LPV RPV PV

UPPER LOWER

PORTAL PLANE & PANCREAS

THE PORTAL PLANE THE OBLIQUE PLANE PASSING BY THE RIGHT AND LEFT BRANCHS OF THE PV, DIVIDES THE LIVER INTO UPPER AND LOWER SEGMENTS. THIS PLANE MAY BE CALLED THE PORTAL PLANE. IN CT AXIAL VEIW THE PORTAL PLANE LIES ABOVE : THE MAIN PORTAL VEIN, THE PANCREAS AND THE UPPER POLES OF KIDNEYS . THIS MEANS THAT THESE STRUCTURES LIE AT THE SAME LEVEL OF THE LOWER LIVER SEGMENTS IN CT AXIAL VEIW.

UPPER SEGMENTS NO PV/NO PANCREAS/ NO KIDNIES

LOWER SEGMENTS PV, CAUDATE, PANCREAS, KIDNEYS IVC