One liver for two: partition of the portal elements

Area of Science:

• Surgical Anatomy
• Transplant Surgery
• Hepatobiliary Surgery

Background:

• Liver transplantation often requires split livers to maximize donor organ utilization.
• Precise anatomical knowledge is crucial for successful liver partitioning and transplantation.

Purpose of the Study:

• To establish the ideal anatomical basis for partitioning portal elements in split-liver procedures.
• To identify critical structures for division to ensure graft viability.

Main Methods:

• Anatomical study of 33 cadaver livers.
• Evaluation of portal vein, hepatic artery, and bile duct anatomy.
• Analysis of vascularization patterns following simulated liver sectioning.

Main Results:

• The left portal vein, right hepatic artery, and left hepatic duct are preferred for sectioning.
• Sectioning the left portal vein requires addressing branches to segment I.
• Division between left medial and lateral segments results in loss of portal venous supply to the medial segment.

Conclusions:

• Optimal liver splitting involves careful consideration of portal venous and arterial supply, as well as biliary drainage.
• Pre-operative cholangiography and arteriography are recommended to identify variations and avoid extensive dissection.
• Understanding these anatomical relationships is vital for successful split-liver transplantation.