Rouviere's sulcus (RS) (i.e., incisura hepatis dextra, Gans incisura) represents an important anatomical landmark. The aim of the study was to determine the frequency of the RS, its description, its location, its relations to the right portal pedicle and to the plane of the common bile duct, and the evaluation of the surgical relevance of the obtained data. Forty macroscopically healthy and undamaged livers were removed during autopsies from cadavers of both sexes. The RS was present in 82% of the cases and in these the open RS was identified in 70% of the livers. The fused type was observed in 12% of the cases; 18% of the livers had no sulcus. The mean length of the open type RS was 28 ± 2 mm (range 24–32 mm) and its mean depth was 6 ± 2 mm (range 4–8 mm). The right posterior sectional pedicle was found in the RS in 70% of the cases. In 5% of the livers, we also dissected a branch of the anterior sectional pedicle. Inside 25% of the RS, we found the vein of segment 6. The RS identification may avoid bile duct injury during laparoscopic cholecystectomy and enables elective vascular control during the right liver resection.
Background: The control of the left hepatic vein (LHV) and the common trunk of the middle hepatic vein (MHV) and LHV (CT) is considered difficult during liver resection and could be improved by detailed knowledge on the ligamentum venosum Arantii (LV). Aim: The aim of this study was to describe the LV and its connections to the LHV and the CT and to present surgical relevance of the obtained data. Material and Methods: During autopsy of 50 cadavers of both sexes, the LV was exposed, measured and then dissected, simulating a surgical maneuver to facilitate the approach to the LHV and CT. The extrahepatic parts of the LHV, MHV and CT were measured. Results: The LV was 52–70 mm long and 5–8 mm thick. It had a fibrotic structure and was not patent in 96% of the cases. The extrahepatic part of the LHV measured 3–19 mm, that of the MHV 3–18 mm and that of the CT 4–15 mm. Conclusion: LV dissection facilitated extraparenchymatous clamping of the hepatic veins: the extrahepatic parts of the LHV and CT measured >3 mm in 86 and 84% of the cases, respectively.
Rapid identification of RAPP is possible by knowing its anatomic variations and its relation with cystic plate.
Background: There are nearly no data on the hepatocaval ligament (HCL) in the anatomical literature, though it is of high importance during surgery of the right hemiliver. Aim: The aim of this study was to determine the frequency of the HCL, its description and its relations to the inferior vena cava (IVC) and the right hepatic vein (RHV) as well as the evaluation of the surgical relevance of the data obtained. Materials and Methods: The dissection of the livers of 43 cadavers of both sexes was performed and the presence of the HCL was established. The ligament was measured and dissected to expose the IVC and the extrahepatic part of the RHV from its inflow to the liver parenchyma. Results: The ligament was present in 77% of the cases. It was 12–35 mm long and 3–18 mm wide. The extrahepatic part of the RHV was 2–12 mm long. Conclusion: Dissection of the HCL revealed the terminal extrahepatic part of the RHV in all cases. Anatomically, resection of the right hemiliver with elective vascular control would be possible in 85% of the cases in which the length of the extrahepatic part of the RHV was ≧3 mm.
The existing knowledge on anatomy of segmental branches of left portal vein (LPV) is limited. This study aims to describe the surgical anatomy and variations of LPV and its segmental branching pattern. Forty fresh cadaveric liver dissections were performed. The dissection of LPV was carried out from its emergence at the level of the portal vein bifurcation to its segmental branches penetrating the left hemiliver. LPV characteristics, the number, and situation of its segmental branches were recorded. LPV comprises two portions: a 28 ± 6.7 mm-long transverse portion (TPLPV) and a 34.9 ± 4.4 mm-long umbilical portion (UPLPV). Mean number of LPV branches to segments I, II, III, and IV was 2 ± 1 (1-6), 2 ± 1 (1-4), 2 ± 1 (1-5), and 8 ± 2 (4-14), respectively. A single large vein supplied segment II in 90% of the cases. Segment III constantly had one vein arising from the left horn of UPLPV with mean diameter of 5.9 ± 1.6 mm. Most of the veins to segment IV took origin from the right horn of UPLPV with a mean number of 5 ± 2 (2-8). Segmental veins arising from UPLPV and TPLPV and supplying segment IV were present in 90 and 45% of the cases respectively. Segmental veins arising from LPV are often multiple and variable in position. Detailed knowledge of these veins is mandatory in order successfully perform anatomical liver resections or monosegment graft harvest for pediatric liver transplantation. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc.
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