Liver Anatomy

Right hepatic vein (RHV): Drains segments V, VI, VII, VIII. Largest of the three. Enters the IVC directly on the right. Must be controlled in right hepatectomy.
Middle hepatic vein (MHV): Drains segments IV, V, and VIII. Courses along the main hepatic scissura (principal plane). Often the key vein in right hepatectomy controversy — whether to include it in the right lobe graft affects outflow and left remnant venous drainage.
Left hepatic vein (LHV): Drains segments II and III. Frequently joins the middle hepatic vein to form a common trunk before entering the IVC (~80% of individuals).

Surgical anatomy of the liver — understanding Couinaud segments, hepatic vasculature, and biliary anatomy is essential for reading imaging reports, understanding liver resections, and making sense of transplant surgery.

Identify each Couinaud segment and explain the surgical significance of the segmental anatomy
Trace the hepatic arterial, portal venous, and biliary anatomy and relate each to common pathological processes
Describe the functional anatomy of the hepatic lobule and acinus in terms of metabolic and toxic injury patterns

Clinical Skills ~28 min · 7 sections Couinaud · LDLT · Vasculature

References

Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5):351-355. PubMed 16258801
Abdalla EK, Denys A, Chevalier P, et al. Total and segmental liver volume variations: implications for liver surgery. Surgery. 2004;135(4):404-410. PubMed 15041964
Marcos A. Right lobe living donor liver transplantation. Liver Transpl. 2000;6(6 Suppl 2):S59-S63. PubMed 11084087
Varotti G, Gondolesi GE, Goldman J, et al. Anatomic variations in right liver living donors. J Am Coll Surg. 2004;198(4):577-582. PubMed 15051012
Skandalakis JE, Skandalakis LJ, Skandalakis PN, et al. Hepatic surgical anatomy. Surg Clin North Am. 2004;84(2):413-435. PubMed 15062653