1. SURGICAL ANATOMY OF THE LIVERBY
DR IBRAHIM GALAL
PROF OF SURGERY, CAIRO UNIVERSITY, EGYPT

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

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

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

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

6. 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.

7. RHV
LHV
MHV
LPV
RPV
MPV
IVC

8. 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

9. CANTLIE’S LINE

10. CANTLIE’S LINE
RT HEMI LIVER
LT HEMI LIVER

11. HEPATIC VEINS (CORONAL CUT)

12. TOP VIEW
RT HEMI LIVER
MHV
LT HEMI LIVER

13. TOP VIEW
RHV
RT HEMI LIVER
MHV

14. TOP VIEW
RPS
RHV
MHV
RAS

15. TOP VIEW
MHV
LHV
LT HEMI LIVER

16. TOP VIEW
MHV
LHV
LMS
LLS

17. SECTORS (TOP)
RPS
RAS
LLS
LMS

18. SECTORS (BOTTOM)
LMS
LLS
RAS
RPS

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

20. LPV
RPV PV

22. UPPER
LOWER

23. PORTAL PLANE
& PANCREAS

24. 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.

25. UPPER SEGMENTS NO PV/NO PANCREAS/ NO KIDNIES

26. LOWER SEGMENTS PV, CAUDATE, PANCREAS, KIDNEYS
IVC