Portal and Hepatic Venous Territorial Mapping in Healthy Human Livers: Virtual Three-Dimensional Computed Tomography...

Area of Science:

• Radiology
• Surgical Anatomy
• Hepatobiliary Surgery

Background:

• Accurate pre-operative assessment of liver anatomy is essential for complex liver resections and transplants.
• Portal and hepatic venous anatomy exhibits significant individual variability, impacting surgical planning.

Purpose of the Study:

• To assess portal and hepatic venous volumes in relation to planning complex liver resections and segmental liver transplants.
• To characterize the territorial anatomy of portal and hepatic veins using 3D computed tomography.

Main Methods:

• Analysis of 3D computed tomography scans from 140 potential living related liver donors.
• Simulation of portal and hepatic vein maps, both separately and in overlap (cross-mapping), to calculate inflow and outflow volumes.

Main Results:

• The right hemiliver was consistently dominant (mean 64.7%).
• The right hepatic vein had the largest drainage volume (mean 40.0%), while the left hepatic vein had the smallest (mean 21.3%).
• Significant individual variability was observed in venous territories, with accessory veins noted in 67 cases.

Conclusions:

• Portal and hepatic vein anatomy shows extensive individual variability, crucial for surgical planning.
• Certain anatomical variations can preclude specific types of liver resections (e.g., extended right hepatectomies).
• Risks such as risky drainage and remnant congestion exist for specific procedures like left trisectionectomy.