[Surgical approach to the dorsal section of the liver]

The dorsal sector of the liver is a deep and posterior territory which lies behind the hilum, close to the inferior vena cava, beneath a plane passing by the terminal portion of the main hepatic veins. Two segments may be distinguished. A left one, segment I, the prominent part of which is the caudate lobe, is united anteriorly with segment IV and lies to the left of the vena cava. A right one, segment IX, is posterior to the right portal pedicle, anterior to the vena cava (at times also to the right), beneath the terminal portion of the right superior and the middle hepatic veins. This dorsal sector is supplied by numerous small ascending portal branches of 1st, IInd and IIIrd order, and efferent veins enter directly the caval stem. The sector lies in the posterior surface of the liver, covered by the mass of the organ and the lesser omentum, fixed posteriorly by the coronary ligament and the entrance of the hepatic veins into the vena cava. However there is always a loose connective tissue between the liver and the vein. Three manoeuvres give access to this dorsal territory: 1. Posterior detachment of the liver by division of the lesser omentum, the falciform and coronary ligaments; the vena cava is then well exposed.(ABSTRACT TRUNCATED AT 250 WORDS)