liver

1. SURGICAL ANATOMY OF THE
LIVER
BY
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. IVC
MPV
LPV
RPV
MHV

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
LT HEMI LIVER

13. TOP VIEW
RT HEMI LIVER
RHV

14. TOP VIEW
RHV
RPS
RAS

15. TOP VIEW
LT HEMI LIVER
LHV

16. TOP VIEW
LHV
LLSLMS

17. SECTORS (TOP)
LLS
LMS
RAS
RPS

18. SECTORS (BOTTOM)
LLSLMS
RAS
RPS

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

20. 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
PV
IVC