Liver morphology: anatomical study about the outer aspects

Srimani, Phalguni; Saha, Anubha

doi:10.1007/s00276-020-02485-9

Cited by 11 publications

(21 citation statements)

References 10 publications

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“…The RL presented with vascular fissures/Rouviere’s sulcus/fissure of Gans (20% specimens) in our study which bears immense surgical significance in laparoscopic cholecystectomy or segmental resection as it aids in recognition of biliary pedicle [ 1 ]. This has only been reported by a few studies ranging between 4.7% to 27.3% [ 1 , 8 ]. Diagnostic imaging errors can be chiefly attributed to accessory fissures.…”

Section: Discussionmentioning

confidence: 99%

“…The segmental liver, although it has gathered immense attention with revisions over time, external variations have acquired consideration only recently and require in-depth study in view of increased interventions and hepatobiliary surgeries. The anatomy of the liver is complex and challenging owing to its widespread morphological variations which present as congenital or acquired, occurring in the form of varied shapes of lobes, fissures, congenital anomalies encompassing agenesis, atrophy or hypoplasia, accessory lobes and fissures, and undue size of a particular lobe, all due to interrupted development at a precise embryonic stage [ 1 , 2 ]. Whereas diaphragmatic, ligamentous anomalies and changes induced by various organs in close relation during lifetime could be the cause for acquired variations.…”

Section: Introductionmentioning

confidence: 99%

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Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications

Saurabh¹,

Krishna²,

Dixit³

et al. 2023

Cureus

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IntroductionWith increasing dependence on laparoscopic procedures, precise knowledge of external variations of the liver is essential for good surgical and interventional outcomes, preventing imaging misdiagnosis, and curtailing complications. The present study aims to evaluate the gross anatomical variations of the liver. Materials and MethodsThe 40 adult cadaveric livers of age 60-80 years were removed during the routine dissection for undergraduate medical students and examined for morphological variations in the form of size, shape, and fissures. ResultsAccessory fissures were observed on the caudate lobe (CL) in 23 (57.5%), on the quadrate lobe (QL) in seven (17.5%), on the right lobe (RL) in 29 (72.5%), and on the left lobe (LL) in 12 (30%) specimens. Netter's Type 2, Type 4, Type 5, Type 6, and Type 7 liver were observed in four (10%), seven (17.5%), one (2.5%), three (7.5%), and three (7.5%) specimens respectively. The most common shapes of the CL and QL were rectangular in 16 (40%) and quadrangular in 10 (25%) specimens respectively. Pons hepatis were seen in three (7.5%) specimens. The mean length (cm) of RL and LL were 17.75 ±3.09 and 16.9±3.69 respectively, whereas the mean transverse diameter (TD) (cm) of RL and LL were 7.98±1.20 and 7.85±1.58 respectively. The mean length and TD (cm) of CL were 5.62±1.67 and 2.48±1.00 respectively. The mean length and TD (cm) of the QL were 6.00±1.51 and 2.81±0.83 respectively. ConclusionPrecise knowledge of these variations would be helpful for surgeons in planning and performing surgical procedures and for anatomists.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications

Saurabh¹,

Krishna²,

Dixit³

et al. 2023

Cureus

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“…14 The above reported rare conditions of 'bipartite' or 'bifid' liver are not usually included in the largest anatomical series describing liver anomalies, which mostly report agenesis of the lobes, absence of segments, deformed lobes, decrease in lobe size, atrophy of the lobes and hypoplastic lobes. [15][16][17][18] A condition of atrophy/hypoplasia of the liver parenchyma can be responsible for this morphological change as observed in those cases in which, due to a parenchymal defect of the medial segment, the hepatic lobes are connected only through a narrow isthmus, which predominantly consists of the caudate lobe and includes the liver hilum. [19][20][21][22][23][24][25] Nowadays in high-volume institutions, 10,26-28 MI robot-assisted liver resection has become a safe technique allowing the gradual extension of indications to more demanding resections, such as approach to posterior segments, major hepatectomies, vascular involvement, large tumour size and number of lesions, as well as cirrhosis or previous surgeries.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Liver Resection and Cholecystectomy Using Indocyanine-Green for Intrahepatic Cholangiocarcinoma, in a Very Rare Anatomical Anomaly of ‘Bipartite Liver’

et al. 2022

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Robotic hepatobiliary surgery has significantly developed worldwide with substantial clinical results. Hepatobiliary anatomical anomalies increase the complexity of hepatobiliary resection with a relevant risk of iatrogenic lesions. Among congenital liver anomalies, the ‘bipartite liver’ is an extremely rare condition which might be associated with complex surgical dissection of the hepatic hilum. We herein report a rare case of congenital ‘bipartite liver’ associated with a cholangiocarcinoma of segment VI and calculous cholecystitis. The patient underwent robot-assisted segmentectomy and cholecystectomy with the use of indocyanine-green cholangiography and intraoperative ultrasound. A challenging hilar dissection was performed using this approach. To the best of our knowledge, this is the first case reported that describes a robot-assisted liver resection and cholecystectomy in a patient having a cholangiocarcinoma associated with this rare liver anomaly. The robotic approach was safe and effective and the 3D preoperative imaging, as well as the intraoperative green-indocyanine cholangiography was extremely useful, especially during hilar dissection and cholecystectomy.

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“…In addition, it is common to find one or several cracks (accessory fissures) on the visceral facies of the right liver [ 23 ]. Srimani et al reported the incidence of accessory fissures in the inferior surface of the right lobe as 27.3% [ 24 ]. If an accessory fissure is close to the gallbladder bed, it may lead to operator misjudgment (faked RS).…”

Section: Discussionmentioning

confidence: 99%

The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

Wang¹,

Hou²,

Zhou³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Rouviere's sulcus (RS) has been widely used as an important landmark during laparoscopic cholecystectomy; however, some shortcomings remain unaddressed. Aim: To evaluate the safety and application values of the hilar plane in laparoscopic cholecystectomy (LC) by comparing it with the plane of Rouviere's sulcus (RS plane). Material and methods: A retrospective study of 155 consecutive patients undergoing LC used the hilar plane as a guide for surgical procedures was performed. Intraoperative images were used to evaluate and analyze the value of using the hilar plane vs. the RS plane in preventing bile duct and vascular injuries. Meanwhile, anatomical data, including the types and orientations of Rouviere's sulci, were also recorded for further analysis. Results: Rouviere's sulci failed to be identified clearly in nine cases due to severe adhesions. The prevalence of RS was 83.6% (122/146). The hilar plane was a constant landmark. The hilar plane can also form a "security dissection triangle" in the posterior triangle of the gallbladder. The hilar plane and the RS plane formed a similar triangle in 59.8% (73/122) of cases, while in other cases, the hilar plane formed a smaller dissection triangle than the RS plane due to a higher spatial position. The hilar plane had a better protective effect for avoiding ectopic hepatic ducts or ectopic right hepatic arteries injury. Conclusions: The hilar plane has the features of constant location, large coverage area, and higher location, hence being further away from the critical structures. The hilar plane on its own can provide a safe anatomic plane in some case when RS was difficult to observe or identify.

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Liver morphology: anatomical study about the outer aspects

Cited by 11 publications

References 10 publications

Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications

Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications

Robot-Assisted Liver Resection and Cholecystectomy Using Indocyanine-Green for Intrahepatic Cholangiocarcinoma, in a Very Rare Anatomical Anomaly of ‘Bipartite Liver’

The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

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