Traditional Surgical Viewpoint of Liver Anatomy

Traditionally, surgeons have had to resect liver tissue using only surface anatomic landmarks to divide the liver into segments. From this view, the surgeon identifies the hepatic artery and portal vein which provide the vascular inflow to the liver, the hepatic veins which provide vascular outflow, and the falciform ligament which lies within the umbilical fissure. Click on the image to view a movie. Note:using Sparkle may cause blurring of MPEG movies.

Surface Anatomy Landmarks

Fig 3-1 Surface projection of the liver

showing the umbilical fissure, gallbladder fossa, inferior vena cava (ivc), and gallbladder..

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The landmarks shown above provide the basis for the traditional nomenclature of liver lobe anatomy, that is, a plane from the inferior vena cava to the gallbladder fossa usually falls along the middle hepatic vein and thus divides the liver into right and left lobes. The line projected onto the surface of the liver by this plane is known as Cantlie's line [Bismuth].

Right and Left Lobes of the Liver

Fig 3-2 Surface Projection of the liver

showing a vertical plane intersecting the gallbladder fossa and inferior vena cava defining the right and left lobes of the liver.

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Lateral and Medial Segments of the Left Lobe

Fig 3-3 Surface Projection of the liver

showing two vertical planes -- the plane intersecting the gallbladder fossa and inferior vena cava defining the right and left lobes of the liver and a plane along the falciform ligament, umbilical fissure, and IVC defining the lateral and medial liver segments.

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The only other division allowed by viewing surface anatomy is a plane through the falciform ligament dividing the left lobe into lateral and medial segments .

The Caudate Lobe

Fig 3-4 Closeup Shaded Surface view of the posterior aspect of the liver and the caudate lobe. It is bounded laterally by the fissure for the ligamentum venosum and medially by the IVC.

Another segment can be viewed on the posterior surface of the liver. This is known as the caudate (also known as Spigel's) lobe. The caudate lobe is anatomically different from other lobes in that it often has direct connections to the IVC through hepatic veins that are separate from the main hepatic veins and may be supplied to both right and left branches of the portal vein.

These surface anatomical land marks do not allow full division of the liver into independent segments. To do this, the deep vascular anatomy needs to be identified. This definition of the vascular inflow and outflow of the liver allows division into the Couinaud segments.

Last modified: Wed Jun 2 11:48:54 CDT