en
Scientific article
Review
English

Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections

Published inJournal of hepatology, vol. 60, no. 3, p. 654-662
Publication date2014
Abstract

The vascular anatomy of the liver can be described at three different levels of complexity according to the use that the description has to serve. The first--conventional--level corresponds to the traditional 8-segments scheme of Couinaud and serves as a common language between clinicians from different specialties to describe the location of focal hepatic lesions. The second--surgical--level, to be applied to anatomical liver resections and transplantations, takes into account the real branching of the major portal pedicles and of the hepatic veins. Radiological and surgical techniques exist nowadays to make full use of this anatomy, but this requires accepting that the Couinaud scheme is a simplification, and looking at the vascular architecture with an unprejudiced eye. The third--academic--level of complexity concerns the anatomist, and the need to offer a systematization that resolves the apparent contradictions between anatomical literature, radiological imaging, and surgical practice. Based on the real number of second-order portal branches that, although variable averages 20, we submit a system called the "1-2-20 concept", and suggest that it fits best the number of actual--as opposed to idealized--anatomical liver segments.

Keywords
  • Liver
  • Segments
  • Couinaud
  • Surgery
  • Anatomy
  • 1-2-20 concept
Citation (ISO format)
MAJNO, Pietro et al. Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections. In: Journal of hepatology, 2014, vol. 60, n° 3, p. 654–662. doi: 10.1016/j.jhep.2013.10.026
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal0168-8278
788views
4downloads

Technical informations

Creation05/20/2014 9:31:00 AM
First validation05/20/2014 9:31:00 AM
Update time03/14/2023 9:15:46 PM
Status update03/14/2023 9:15:45 PM
Last indexation01/16/2024 10:44:59 AM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack