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A plea for clinically oriented anatomy.

Clinical anatomy (New York, N.Y.)·2018
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Human liver territories: Think beyond the 8-segments scheme.

Jean H D Fasel1

  • 1Departments of Cell Physiology, Metabolism, and Surgery, Clinical Anatomy Research Group, University Medical Centre and Hospitals, Geneva, Switzerland.

Clinical Anatomy (New York, N.Y.)
|August 10, 2017
PubMed
Summary

The established eight-segment liver model by Couinaud faces challenges from new anatomical and radiological findings. This viewpoint aims to explain these liver inconsistencies for personalized surgical approaches.

Keywords:
1-2-20 conceptCouinaudhuman liversegments

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Area of Science:

  • Anatomy
  • Surgical Interventions
  • Medical Imaging

Background:

  • The Couinaud system, dividing the liver into eight segments based on portal venous supply, is widely adopted globally.
  • Recent anatomical, radiological, and surgical observations have increasingly reported discrepancies with the traditional Couinaud model.
  • These inconsistencies highlight potential limitations in the current understanding of liver compartmentalization.

Purpose of the Study:

  • To provide a viewpoint that clarifies the inconsistencies observed with the established eight-segment liver model.
  • To enhance the understanding of variations in liver anatomy and vascularization.
  • To offer a foundation for developing customized liver interventions based on individual patient anatomy.

Main Methods:

  • Review and synthesis of existing anatomical, radiological, and surgical literature.
  • Comparative analysis of reported observations against the Couinaud segmentation scheme.
  • Development of a conceptual framework to explain observed discrepancies.

Main Results:

  • Identification of specific anatomical and vascular variations that challenge the universal applicability of the Couinaud system.
  • Explanation of how these variations can lead to misinterpretations in imaging and surgical planning.
  • Demonstration of the need for a more nuanced approach to liver segmentation.

Conclusions:

  • The traditional eight-segment liver model requires re-evaluation in light of emerging evidence.
  • Understanding anatomical variations is crucial for accurate liver surgery planning.
  • This work supports the development of patient-specific strategies for liver interventions.