Liver anatomy - history, lobes, segments (by D. Shamrai, Armata manus). Lecture plan: 1)History; 2) Basic knowledge about liver anatomy; 3) Classifications of liver segments; 4) Brisbane terminology; 5) Lodus caudatus (few words about cauda); 6) Arteries part I – variant anatomy of celial trunk. Contact me: shamraydv@gmail.com

1. Liver anatomy – history,
lobes, segments
Shamrai D.V.

2. “A good knowledge of the anatomy is a
prerequisite for modern surgery of the liver”
H. Bismuth

3. Lecture Plan
 History;
 Basic knowledge about liver anatomy;
 Classifications of liver segments;
 Brisbane terminology;
 Lodus caudatus (few words about cauda);
 Arteries part I – variant anatomy of celial
trunk.

4.  Galen (130 BC)
1716 - G. Berta performed the first partial liver excision;
1874 - C.Langenbuch reported the first successful liver resection;
1888 (H. Rex), 1898 (J. Cantlie) found that the left and right lobes
were of equal size (described ‘surgical’ lobe).

5. In 1951 - C. Hjorstö studied placement of
biliary ducts and hepatic artery branches,
discribed 5 liver segments;
1957 - C. Couinaud 8 liver segments, based on
third order portal vein distribution;
1963 - T. Starzl performed
the first human liver
transplantation in a
patient with
biliary atresia.

6. Surface projection
of liver
LII-LIII
Th IX
V rib
X rib

7. Lobes - Diaphragmatic Surface

8. Lobes-Visceral
Surface

10. Peritoneum and
liver

17. Terminology in liver anatomy
• Sector – according to portal vein branches;
• Section – according to bile ducts and hepatic
artery branches;
• Segment – according to 3rd division of hepatic
triad;
• Subsegment – in future lecture.

18. The summary of the classifications
of the liver
A+b.d. PV+HV PV+HV+A+bd

19. Couinaud segments (1957)

22. Bismuth classification

23. Why division according to PV was
better?
“Because portal vein variants of the first-order
branches is found in 23.5% of livers, while
arteriobiliary variants of first-order branches is
found in 50%”

24. IHPBA Brisbane 2000 terminology
of liver anatomy
Section

25. To understand CT better

26. Japanese terminology
• IVa Sg – inferior, IVb Sg – superior;
• Paracaval segment (IX Sg).

27. Synonyms or different structures?
• Lobus caudatus;
• Spiegel lobe;
• Processus caudatus;
• Paracaval segment;
• Segment IX;
• Segment I.

28. Lobus caudatus – right,left or
separate lobe
• Not lobe, but segment;
• Autonomous segment vascularization is
independent portal division and three main
hepatic veins. portal vein and hepatic artery:
its hepatic veins are
• Drains directly into the inferior vena cava (by
short hepatic veins).

31. Liver plates

33. Вариантная
анатомия
tr.coeliacus

37. • Replacing artery;
• Accesorial (additional) artery.
Get ready to see intraoperative fotos

38. Intraoperative fotos and materials
of liver preparation were deleted
from this presentation

39. To be continued…
• Arteries, portal vein branches, bile ducts,
hepatic veins;
• Portal venous system.
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