New Liver Anatomy: Portal Segmentation and the Drainage Vein

by Munemasa Ryu, Akihiro Cho

Overview

A new era for liver anatomy has dawned. With the development of multidetector row computed tomography (MDCT) in the 1990s, precise volume-rendered 3-D images could be constructed, leading to new observations. Liver anatomy has since been reevaluated from the standpoint of portal segmentation and drainage veins and includes a reclassification of the liver. Better surgical results and fewer complications have supported the rationale for the new liver anatomy. Based on the work and spirit of Team Chiba from Chiba University, this publication is a testament to the collaboration, perseverance, and innovation in the field of liver anatomy. With high regard for the early pioneers in this field, Team Chiba can be credited with pioneering its own antiviral treatment, percutaneous ethanol injection therapy, radiation therapy, and US-guided hepatic resections. It is the team's hope that the new liver anatomy will find acceptance worldwide and will contribute to the advancement of the health and welfare of mankind.

Product Details

ISBN-13:	9784431563204
Publisher:	Springer Japan
Publication date:	08/23/2016
Edition description:	2009
Pages:	191
Product dimensions:	8.27(w) x 10.98(h) x (d)

Table of Contents

Reclassification of the Liver.- Previous Liver Anatomy.- Liver Volume from the Point of View of Portal Flow (Normal Liver): Region Growing Method.- Embryology.- Right-Sided Round Ligament.- Left Portal Vein.- Relationship Between Left Hepatic Duct and Left Portal Vein.- Right Portal Vein.- Right Hepatic Duct.- Right Paramedian Sector.- Right Lateral Portal Vein Ramification.- Anatomy of the Hepatic Vein.- The Caudate Lobe and Its Portal Vein Supply.- Caudate Lobe Bile Duct.- Hilar Plate System.- Clarification of Some of Couinaud’s Anatomical Variations Based on the Embryological Development of the Liver.- Opening the Anterior Fissure.- New Surgical Technique According to New Anatomy.- S2 (Left Lateral Superior Segment) Resection.- Left Lateral Inferior (S3) Resection.- Left Paramedian sector (S3, S4) Resection.- Right Paramedian Sector Resection.- Anterior Segmental Resection.- Anterosuperior Segmental Resection.- Anteroinferior Segmental Resection.- Anterior + Caudate Lobe Resection for Hilar Cholangiocarcinoma.- Total Resection of the Drainage Area of the Middle Hepatic Vein (S4 + Anterior Segment).- Inferior Half-Resection of the Drainage Area of the Middle Hepatic Vein (S4a + Anteroinferior Segment).- Left Hepatic Lobe + Anteroventral Segmentectomy.- Resection of Left Hepatic Lobe + Anterior + Caudate Lobe for Cholangiocarcinoma.- Resection of Left Paramedian + Anterosuperior Segments.- Resection of Middle Segment.- Middle Superior Segmental Resection.- Right Lateral (Posterior) + Middle Segments Resection: Total Resection of the Right Hepatic Vein Drainage Area.- Right Lateral (Posterior) Segmental Resection.- Special Anatomy in Difficult Situations During Surgery.

Editorial Reviews

From the reviews: “This book describes a new anatomic classification scheme for liver segmental anatomy. … the audience is hepatobiliary surgeons, transplant surgeons and fellows also will find it of interest. … The book is concisely written and each chapter is accompanied by high quality radiographic images and drawings, the majority of which are in color. This is a valuable contribution to the hepatobiliary field. … the surgical chapters will benefit all hepatobiliary surgeons’ operative planning.” (Zoe Stewart, Doody’s Review Service, February, 2010)

From the Publisher

Reviewer: Zoe Stewart, MD, PhD (University of Iowa Hospitals and Clinics)
Description: This book describes a new anatomic classification scheme for liver segmental anatomy. The authors' anatomic model divides the liver into right and left lobes each composed of three segments, in addition to the caudate lobe. The left lobe segments are unchanged from those originally defined by Couinaud. The right lobe segments in the new model are the anterior segment, middle segment, and right lateral segment. After a thorough description of the new segmental anatomy (including a detailed embryologic review to help understand the proposed new anatomy), the authors proceed to describe 17 surgical resections based upon their anatomic model, with two additional surgical technique chapters for special anatomic variations. Each of these operative chapters is accompanied by multiple 3D CT scan reconstructions that were critical to development of the model.
Purpose: After over two decades of experience with liver resections, the authors began to reevaluate the use of Couinaud segmental anatomy with resection based upon the hepatic veins. In particular, the development of high resolution CT scanners and 3D reconstructions led the authors to conclude that a modification to the liver segmental anatomy could lead to improved outcomes after hepatic resection. Most hepatobiliary surgeons who currently have minimal complications with standard hepatic resections will argue that the new classification system is unnecessary. However, it is likely that the use of intraoperative ultrasound to guide resections currently results in the implementation of several of the anatomic principles raised by the authors. Further, there may be situations when preservation of even a limited section of liver may be critical. The book effectively achieves the intended purpose.
Audience: Although the audience is hepatobiliary surgeons, transplant surgeons and fellows also will find it of interest. The authors are recognized leaders in hepatobiliary surgery and lead one of the busiest hepatobiliary programs in Japan.
Features: The authors describe the historical liver anatomic models and then the radiographic and embryologic basis for their new segmental model. They then describe in detail the vascular anatomy in relationship to the biliary tract, including a discussion of several anatomic variants that may be encountered during resection. A series of 18 chapters detail surgical techniques. The book is concisely written and each chapter is accompanied by high quality radiographic images and drawings, the majority of which are in color.
Assessment: This is a valuable contribution to the hepatobiliary field. The detailed text is accompanied by extensive radiographic images and anatomic drawings that convey the complex anatomic relationships with great clarity. Further, the surgical chapters will benefit all hepatobiliary surgeons' operative planning.

Doody's Review Service