- The liver is the largest gland in the body and has a wide variety of functions - Weight: 1/50 of body weight in adult & 1/20 of body weight in infant - It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen) Function of the liver : - Secretion of bile & bile salt - Metabolism of carbohydrate, fat and protein - Formation of heparin & anticoagulant substances - Detoxication - Storage of glycogen and vitamins - Activation of vita .D

1. Surgical Anatomy of the Liver -Surgical Anatomy of the Liver -
ΗΗepatectomiesepatectomies
Dimitris P. Korkolis
Surgeon
Saint Savvas Anticancer - Oncological Hospital of Athens

2. Liver
• The liver is the largest gland in the body and has a wide variety of
functions
• Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
• It is exocrine(bile) & endocrine organ(Albumin , prothrombin &
fibrinogen)
• Function of the liver
• Secretion of bile & bile salt
• Metabolism of carbohydrate, fat and protein
• Formation of heparin & anticoagulant substances
• Detoxication
• Storage of glycogen and vitamins
• Activation of vita .D

3. EmbryologyEmbryology
 44thth
Week of DevelopmentWeek of Development
– Projection from ventral wall of MidgutProjection from ventral wall of Midgut
 Cranial BudCranial Bud →→ LiverLiver
 Caudal BudCaudal Bud →→ Gallbladder, extrahepaticGallbladder, extrahepatic
biliary treebiliary tree
 Ventral PancreasVentral Pancreas

4. EmbryologyEmbryology
 Bile ducts develop from hepatocytes,Bile ducts develop from hepatocytes,
originating at hilumoriginating at hilum
 77thth
WeekWeek
– Biliary lumen recanalizeBiliary lumen recanalize
 1212thth
WeekWeek
– Liver begins to secrete bileLiver begins to secrete bile

5. DevelopmentalDevelopmental
AnomaliesAnomalies
 Agenesis rareAgenesis rare
– Left lobe agenesis reportedLeft lobe agenesis reported
 Reidel’s LobeReidel’s Lobe
– Long tongue of liver extending inferiorlyLong tongue of liver extending inferiorly
from right lobefrom right lobe
– Usually asymptomatic, may beUsually asymptomatic, may be
associated with colonic or pyloricassociated with colonic or pyloric
obstructionobstruction
 Heterotopic liver tissueHeterotopic liver tissue
– Gallbladder, pancreas, adrenals,Gallbladder, pancreas, adrenals,

6. AnatomyAnatomy
 PositionPosition
– Between 4Between 4thth
intercostalintercostal
space and costal marginspace and costal margin
– extends across midlineextends across midline

7. AnatomyAnatomy
 Glisson’s CapsuleGlisson’s Capsule
– Peritoneal MembranePeritoneal Membrane
 PeritoneumPeritoneum
– Bare patch under diaphragm next to IVCBare patch under diaphragm next to IVC

8. LigamentsLigaments
 FalciformFalciform
– Attaches to anterior abdominal wall fromAttaches to anterior abdominal wall from
diaphragm to umbilicusdiaphragm to umbilicus
– Includes Ligamentum Teres (roundIncludes Ligamentum Teres (round
ligament) at inferior borderligament) at inferior border
 Former Umbilical VeinFormer Umbilical Vein
 May recanalize in portal hypertension, orMay recanalize in portal hypertension, or
malignant hematologic disordersmalignant hematologic disorders

9. LigamentsLigaments
 Right and Left CoronaryRight and Left Coronary
– Connect diaphragm to liverConnect diaphragm to liver
– Lateral aspects become TriangularLateral aspects become Triangular
LigamentsLigaments

10. LigamentsLigaments
 GastrohepaticGastrohepatic
– Anterior layer of lesser omentumAnterior layer of lesser omentum
– Continuous with Left Triangular LigamentContinuous with Left Triangular Ligament
 HepatoduodenalHepatoduodenal
– Anterior border of Foramen of WinslowAnterior border of Foramen of Winslow
– Contains Portal TriadContains Portal Triad

11. The Ligamentum
Venosum
-Fibrous band that is the
remains of the ductus
venosus
-Ligament of Aranthius
- It is attached to the left
branch of the portal vein
and ascends in a fissure on
the visceral surface of the
liver to be attached above
to the inferior vena cava

12. Topographic AnatomyTopographic Anatomy
 RightRight
 LeftLeft
 QuadrateQuadrate
 CaudateCaudate

13. Lobar AnatomyLobar Anatomy
(American System)(American System)
 Right and Left Lobe determined by Cantlie’sRight and Left Lobe determined by Cantlie’s
Line (portal fissure)Line (portal fissure)
– Gallbladder Fossa to IVCGallbladder Fossa to IVC

14. •Claude Couinaud
1922 - 2008

15. Segmental AnatomySegmental Anatomy
(Couinaud System)(Couinaud System)
 Caudate LobeCaudate Lobe
– Segment ISegment I
 Left LobeLeft Lobe
– Segments II – IVSegments II – IV
 Right LobeRight Lobe
– Segments V-VIIISegments V-VIII

16. Segmental AnatomySegmental Anatomy
(Couinaud System)(Couinaud System)
 Caudate LobeCaudate Lobe
– Segment ISegment I
 Left LobeLeft Lobe
– Segments II – IVSegments II – IV
 Right LobeRight Lobe
– Segments V-VIIISegments V-VIII

17. Blood supply of the liver
• Proper hepatic artery 
The right and left hepatic
arteries enter the porta
hepatis.
• The right hepatic artery
usually gives off the cystic
artery, which runs to the
neck of the gallbladder.

18. Blood supply of the liver

19. Portal VeinPortal Vein
 75% of hepatic blood75% of hepatic blood
flowflow
 1-3cm diameter1-3cm diameter
 5-8cm length5-8cm length
 4-5mm Hg4-5mm Hg

20. Portal VeinPortal Vein
 Laminar Blood flowLaminar Blood flow
– Affects distribution of amebic abscesses andAffects distribution of amebic abscesses and
tumor metastasestumor metastases

21. Portal-SystemicPortal-Systemic
communicationcommunication
 Submucosal veins of distal esophagus andSubmucosal veins of distal esophagus and
proximal stomachproximal stomach
 Umbilical and periumbilical veinsUmbilical and periumbilical veins
– Caput MedusaeCaput Medusae
– Cruveilhier-Baumgarten bruitCruveilhier-Baumgarten bruit
 Tributaries of inferior mesenteric veinsTributaries of inferior mesenteric veins
– Superior hemmorhoidalsSuperior hemmorhoidals
 Retroperitoneal communicationRetroperitoneal communication
– Adrenal veinsAdrenal veins

22. Hepatic ArteryHepatic Artery

23. Hepatic ArteryHepatic Artery
 CautionsCautions
– Only 55-65% of population has “normal”Only 55-65% of population has “normal”
hepatic arterial anatomyhepatic arterial anatomy
– Aberrant R hepatic artery may beAberrant R hepatic artery may be
mistaken for cystic arterymistaken for cystic artery
– Cystic artery may originate from theCystic artery may originate from the
gastroduodenal artery, the left hepaticgastroduodenal artery, the left hepatic
artery, or the common hepatic arteryartery, or the common hepatic artery

24. Biliary SystemBiliary System
 Triangle of CalotTriangle of Calot
– Cystic Duct, Common Hepatic Duct, andCystic Duct, Common Hepatic Duct, and
hilum of liverhilum of liver

25. Biliary AnomaliesBiliary Anomalies

26. Hepatic VeinsHepatic Veins
 Short extrahepaticShort extrahepatic
segmentsegment
– RightRight
– MiddleMiddle
 Usually joins leftUsually joins left
– LeftLeft
 Direct communication to IVC fromDirect communication to IVC from
Segment I (caudate)Segment I (caudate)

27. LymphaticsLymphatics

28. LIVER Histology
• lobules >> roughly
hexagonal structures
consisting of
hepatocytes. Radiate
outward from a central
vein.
• At each of the six
corners of a lobule is a
portal triad
( p.arteriole,p.venule &
bile duct)
•Between the
hepatocytes are the
liver sinusoids.

29. Where do the two blood supplies mix?
• Liver surrounded by a thin capsule at
portahepatic(it is thick)Glisson’s
capsule invests the liver and send septa
into liver subset subdivide the
parenchyma into lobules

31. Segmental anatomy of the liver
• Rt .& Lt. lobes anatomically no
morphological significance.
Separation by ligaments
(Falciform, lig. Venoosum &
Lig.teres)
• True morphological and
physiological division by a line
extend from fossa of GD to fossa
of I.V.C each has its own arterial
blood supply, venous drainage
and biliary drainage
• No anastomosis between
divisions
• 3 major hepatic veins  Rt, Lt &
central
• 8 segments based on hepatic and
portal venous segments

32. Segmental anatomy of the liver
– Liver segments are based on the portal and
hepatic venous segments

34. •Source: HPB 2000; 2(3):333-39
•Terminology Committee of the International Hepato-Pancreato-Biliary Association