The document discusses liver anatomy, emphasizing its historical development and classifications, including various segments based on portal vein distribution. Key milestones include early liver surgeries, advancements in segment classification, and terminology variations across different anatomical perspectives. It highlights the importance of understanding liver anatomy for modern surgical practices.

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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