surgical classification of liver with figures and videos, simple explanation , cantlie line , hepatectomy

1. LIVER SEGMENTS
Sidoun M
Surgery department
MCC

2. ANATOMICAL
CLASSIFICATION:the falciform ligament, the most obvious surface marker of the liver,
was used as the division of the right and left lobes of the liver, this
description is inaccurate and of minimal usefulness to the surgeon
and radiologist .

3. Surgical classification:
(James Cantlie, Scottish surgeon1851-1926 )
cantlie line extending from the gallbladder to the left side of the
inferior vena cava, representing bloodless area that can be
considered to divide the liver into left and right parts.
(The French surgeon and anatomist Claude Couinaud) classification
system uses the vascular supply in the liver to separate the
functional units (numbered I to VIII)
The hepatic veins are at the periphery each segment,
portal triad at center each segment

7. RIGHT LOBE :ANTERIOR 5,8 POSTERIOR 6,7
LEFT LOBE :MEDIAL 4A AND B LATERAL 23
SEGMENT 1 IS POSTERIOR TO THE LIVER ,ANTERIOR
AND LATERAL TO IVC (CAUDATE)IN THE CENTER OF ALL
SEGMENTS OF THE LIVER FROM POSTERIOR,

9. PORTAL VEIN BRANCHES :

10. IVC TRIBUTARIES FROM LIVER
The right hepatic vein runs at the right hepatic fissure and
drains segments V, VI, VII and VIII. The plane of the right hepatic
vein separates the segments VI and VII posterior and segments
VIII and V anterior .
The middle hepatic vein runs at the middle hepatic fissure and
drains segments IV, V and VIII. The plane of the middle hepatic
vein separates the segments VIII and V from segment IV
left hepatic vein runs partially at the fissure for the ligamentum
teres and at the left hepatic fissure , drains segments II, III, and
IV. the plane of the left hepatic vein separates segment IV from
segments II and III.

12. CT SCAN CLASSIFICATION OF
LIVER :
Important land marks :
1. Caudate lobe :direct contact to the IVC
2. Spleen ,stomach ,splenic and hepatic flexure ,ivc inside the liver,
____from medial to lateral 2,4a,8 ,7 (upper)
3. Splenic vein,main portal vein,pancreas :the inferior segments 5,6
4. Gall bladder between s 4 ,5
5. Liver fissures :medially fissure for ligamentum teres ( start on the
costal surface of liver as falciforum ligament ) divide left lobe medially s
and lateral s laterally is fissure for portal vein ,the gall bladder lies in
this fissure (continuation anterior to the caudate) to be fissure for
ligamentum venosum separate the caudate from the left lobe .

13. RIGHT HEPATECTOMY
RIGHT HEPATIC FISSURE
Posterior
segments
anterior segments

14. LEFT HEPATECTOMY

17. REFERENCES:
1. O. Al-Jiffry Bilal and Khayat H. Samah (2013). Segmental Oriented Liver Surgery,
Hepatic Surgery, chapter 9
2. Craig Hacking , Omar Bashir et al. (n.d)hepatic veins , radiopedia.org ,
https://radiopaedia.org/articles/hepatic-veins
3. Segmental liver anatomy (n.d) retrived from
http://snmmi.files.cms-plus.com/docs/PET_COE/off_the_wall/Segmental.pdf
4. Video retrived from tvasurg.com ,
http://pie.med.utoronto.ca/TVASurg/TVASurg_content/surg/PL_standardRightHe
patectomy.html
5. Second video retrived from ,
https://www.youtube.com/channel/UCJQWLA8-dDPqJc3COrFYi-w