Segmenti Epatici - Chirurgia Del Fegato

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Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

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Segmenti epatici

Segmenti del fegato, anatomia segmentaria del fegato

Cosa sono i segmenti epatici?

I segmenti epatici sono le unità anatomiche e funzionali che costituiscono il fegato.

Sono dei moduli indipendenti l’uno dall’altro e ognuno è provvisto di:

• una arteria che porta il sangue arterioso ossigenato ad un determinato segmento epatico;
• una vena che conduce allo stesso segmento il sangue che proviene dall’intestino e dalla milza;
• una via biliare che porta il prodotto del funzionamento di quel determinato segmento del fegato, la bile, nell’intestino.

Queste tre strutture decorrono insieme, l’una accanto all’altra, nei peduncoli glissoniani, che rappresentano lo scheletro vero e proprio del fegato.

Ogni segmento è anche dotato di una o più vene epatiche che portano il sangue fuori dallo stesso segmento, per farlo rientrare nella circolazione generale.

Quanti e quali sono i segmenti del fegato?

Classicamente il fegato viene diviso in 8 segmenti.

• Il segmento epatico 1 si chiama anche “lobo caudato”; è localizzato nella parte centrale e posteriore del fegato;
• Il segmento epatico 2 si trova nella parte posteriore di sinistra del fegato;
• Il segmento epatico 3 si trova nella parte anteriore di sinistra del fegato;
• Il segmento epatico 4 si trova nella zona più centrale della parte sinistra del fegato; confina alla sua sinistra con i segmenti 2 e 3; confina alla sua destra con i segmenti 5 e 8; il segmento epatico 4 è a sua volta diviso in due subsgmenti a loro volta autonomi: il segmento 4a occupa la zona più posteriore ed è situato fra segmento 2 (a sinistra) e segmento 8 (a destra); il segmento 4b occupa la zona più anteriore ed è situato fra segmento 3 (a sinistra) e segmento 5 (a destra);
• Il segmento epatico 5 si trova nella zona più anteriore della parte centrale del fegato di destra; confina posteriormente con il segmento 8, alla sua sinistra con il segmento 4 e alla sua destra con il segmento 6;
• Il segmento epatico 6 si trova nella zona più anteriore della parte laterale del fegato di destra; confina posteriormente con il segmento 7; alla sua sinistra con il segmento 5;
• Il segmento epatico 7 si trova nella zona più posteriore della parte laterale del fegato di destra; confina anteriormente con il segmento 6; alla sua sinistra con il segmento 8;
• Il segmento epatico 8 si trova nella zona più posteriore della parte centrale del fegato di destra; confina anteriormente con il segmento 5; alla sua sinistra con il segmento 4 ed alla sua destra con il segmento 7.

Quindi, come è diviso il fegato?

Il fegato viene diviso in due porzioni, ognuna composta da quattro segmenti epatici:

• l’emifegato di sinistra è costituito dai segmenti 2, 3, 4a e 4b;
• l’emifegato di destra è costituito dai segmenti 5, 6, 7 e 8.
• il segmento epatico 1, detto anche lobo caudato è situato nella parte posteriore del fegato. Costituisce in parte il fegato di sinistra (lobo caudato di sinistra) e in parte il fegato di destra (lobo caudato di destra).

Come si identifica il territorio di ciascun segmento? (la superficie del fegato è liscia!)

Il territorio di ogni segmento viene identificato in base all’apporto di sangue che viene veicolato ad una determinata zona del fegato dai peduncoli glissoniani in maniera autonoma.

Nel fegato la divisione di terz’ordine dei peduncoli glissoniani (che contengono ciascuno un ramo dell’arteria epatica, una branca della vena porta ed un ramo della via biliare) porta in effetti alla formazione di 8 peduncoli autonomi per gli 8 segmenti principali del fegato (dal segmento 2 al segmento 8).

Come si definisce in definitiva l’anatomia dei segmenti del fegato?

L’anatomia del fegato si definisce quindi in base alla divisione progressiva dei peduncoli glissoniani all’interno del fegato, secondo il seguente schema:

• Divisione di primo ordine:

Peduncolo glissoniano di sinistra per l’emifegato di sinistra (segmenti 2, 3, 4a e 4b);

Peduncolo glissoniano di destra per l’emifegato di destra (segmenti 5, 6, 7 e 8); 

 

• Divisione di secondo ordine:

A sinistra:

Sezione laterale di sinistra (segmenti 2 e 3) (una volta si chiamava “lobo epatico di sinistra”)

Sezione centrale di sinistra (segmenti 4a e 4b)

A destra:

Sezione anteriore di destra (segmenti 5 e 8)

Sezione posteriore di destra (segmenti 6 e 7)

• Divisione di terz’ordine:

Un peduncolo singolo per ciascuno degli 8 segmenti

Da questa divisione dei peduncoli glissoniani deriva quindi lo studio e la determinazione dell’anatomia dei segmenti epatici nel singolo paziente e la classificazione degli interventi anatomici di resezione epatica.

Dove posso trovare un qualche articolo che mi descriva più in dettaglio i segmenti epatici?

2023

Aoki T; Matsuda K

Hepatic Segmentation Book Section

In: Fluorescence-Guided Surgery, pp. 183–193, Springer Nature Singapore, Singapore, 2023.

Links | BibTeX

@incollection{Aoki2023-fl, title = {Hepatic Segmentation}, author = {Takeshi Aoki and Kazuhiro Matsuda}, url = {https://link.springer.com/chapter/10.1007/978-981-19-7372-7_26}, doi = {10.1007/978-981-19-7372-7_26}, year = {2023}, date = {2023-01-01}, urldate = {2023-01-01}, booktitle = {Fluorescence-Guided Surgery}, pages = {183–193}, publisher = {Springer Nature Singapore}, address = {Singapore}, keywords = {}, pubstate = {published}, tppubtype = {incollection} }

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• https://link.springer.com/chapter/10.1007/978-981-19-7372-7_26
• doi:10.1007/978-981-19-7372-7_26

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2022

Wakabayashi G; Cherqui D; Geller D A; Hilal M A; Berardi G; Ciria R; Abe Y; Aoki T; Asbun H; Chan A C Y; Chanwat R; Chen K; Chen Y; Cheung T T; Fuks D; Gotohda N; Han H; Hasegawa K; Hatano E; Honda G; Itano O; Iwashita Y; Kaneko H; Kato Y; Kim J; Liu R; López-Ben S; Morimoto M; Monden K; Rotellar F; Sakamoto Y; Sugioka A; Yoshiizumi T; Akahoshi K; Alconchel F; Ariizumi S; Cacciaguerra A B; Durán M; Vazquez A G; Golse N; Miyasaka Y; Mori Y; Ogiso S; Shirata C; Tomassini F; Urade T; Wakabayashi T; Nishino H; Hibi T; Kokudo N; Ohtsuka M; Ban D; Nagakawa Y; Ohtsuka T; Tanabe M; Nakamura M; Tsuchida A; Yamamoto M

The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system Journal Article

In: Journal of Hepato-Biliary-Pancreatic Sciences, vol. 29, no 1, pp. 6 – 15, 2022, ISSN: 18686974, (Cited by: 6).

Abstract | Links | BibTeX

@article{Wakabayashi20226, title = {The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system}, author = {Go Wakabayashi and Daniel Cherqui and David A. Geller and Mohammed Abu Hilal and Giammauro Berardi and Ruben Ciria and Yuta Abe and Takeshi Aoki and Horacio J. Asbun and Albert C. Y. Chan and Rawisak Chanwat and Kuo-Hsin Chen and Yajin Chen and Tan To Cheung and David Fuks and Naoto Gotohda and Ho-Seong Han and Kiyoshi Hasegawa and Etsuro Hatano and Goro Honda and Osamu Itano and Yukio Iwashita and Hironori Kaneko and Yutaro Kato and Ji Hoon Kim and Rong Liu and Santiago López-Ben and Mamoru Morimoto and Kazuteru Monden and Fernando Rotellar and Yoshihiro Sakamoto and Atsushi Sugioka and Tomoharu Yoshiizumi and Keiichi Akahoshi and Felipe Alconchel and Shunichi Ariizumi and Andrea Benedetti Cacciaguerra and Manuel Durán and Alain Garcia Vazquez and Nicolas Golse and Yoshihiro Miyasaka and Yasuhisa Mori and Satoshi Ogiso and Chikara Shirata and Federico Tomassini and Takeshi Urade and Taiga Wakabayashi and Hitoe Nishino and Taizo Hibi and Norihiro Kokudo and Masayuki Ohtsuka and Daisuke Ban and Yuichi Nagakawa and Takao Ohtsuka and Minoru Tanabe and Masafumi Nakamura and Akihiko Tsuchida and Masakazu Yamamoto}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85123901612&doi=10.1002%2fjhbp.1091&partnerID=40&md5=6f9e9231b8cbd8b84b02db4d4c118e4c}, doi = {10.1002/jhbp.1091}, issn = {18686974}, year = {2022}, date = {2022-01-01}, urldate = {2022-01-01}, journal = {Journal of Hepato-Biliary-Pancreatic Sciences}, volume = {29}, number = {1}, pages = {6 – 15}, publisher = {John Wiley and Sons Inc}, abstract = {Background: The Brisbane 2000 Terminology for Liver Anatomy and Resections, based on Couinaud’s segments, did not address how to identify segmental borders and anatomic territories of less than one segment. Smaller anatomic resections including segmentectomies and subsegmentectomies, have not been well defined. The advent of minimally invasive liver resection has enhanced the possibilities of more precise resection due to a magnified view and reduced bleeding, and minimally invasive anatomic liver resection (MIALR) is becoming popular gradually. Therefore, there is a need for updating the Brisbane 2000 system, including anatomic segmentectomy or less. An online "Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (PAM-HBP Surgery Consensus)" was hosted on February 23, 2021. Methods: The Steering Committee invited 34 international experts from around the world. The Expert Committee (EC) selected 12 questions and two future research topics in the terminology session. The EC created seven tentative definitions and five recommendations based on the experts’ opinions and the literature review performed by the Research Committee. Two Delphi Rounds finalized those definitions and recommendations. Results: This paper presents seven definitions and five recommendations regarding anatomic segmentectomy or less. In addition, two future research topics are discussed. Conclusions: The PAM-HBP Surgery Consensus has presented the Tokyo 2020 Terminology for Liver Anatomy and Resections. The terminology has added definitions of liver anatomy and resections that were not defined in the Brisbane 2000 system. © 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery}, note = {Cited by: 6}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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Background: The Brisbane 2000 Terminology for Liver Anatomy and Resections, based on Couinaud’s segments, did not address how to identify segmental borders and anatomic territories of less than one segment. Smaller anatomic resections including segmentectomies and subsegmentectomies, have not been well defined. The advent of minimally invasive liver resection has enhanced the possibilities of more precise resection due to a magnified view and reduced bleeding, and minimally invasive anatomic liver resection (MIALR) is becoming popular gradually. Therefore, there is a need for updating the Brisbane 2000 system, including anatomic segmentectomy or less. An online "Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (PAM-HBP Surgery Consensus)" was hosted on February 23, 2021. Methods: The Steering Committee invited 34 international experts from around the world. The Expert Committee (EC) selected 12 questions and two future research topics in the terminology session. The EC created seven tentative definitions and five recommendations based on the experts’ opinions and the literature review performed by the Research Committee. Two Delphi Rounds finalized those definitions and recommendations. Results: This paper presents seven definitions and five recommendations regarding anatomic segmentectomy or less. In addition, two future research topics are discussed. Conclusions: The PAM-HBP Surgery Consensus has presented the Tokyo 2020 Terminology for Liver Anatomy and Resections. The terminology has added definitions of liver anatomy and resections that were not defined in the Brisbane 2000 system. © 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery

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• https://www.scopus.com/inward/record.uri?eid=2-s2.0-85123901612&doi=10.1002%[...]
• doi:10.1002/jhbp.1091

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2017

Sugioka A; Kato Y; Tanahashi Y

Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule: proposal of a novel comprehensive surgical anatomy of the liver Journal Article

In: Journal of Hepato-Biliary-Pancreatic Sciences, vol. 24, no 1, pp. 17 – 23, 2017, ISSN: 18686974, (Cited by: 105; All Open Access, Green Open Access, Hybrid Gold Open Access).

Abstract | Links | BibTeX

@article{Sugioka201717, title = {Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule: proposal of a novel comprehensive surgical anatomy of the liver}, author = {Atsushi Sugioka and Yutaro Kato and Yoshinao Tanahashi}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85011617124&doi=10.1002%2fjhbp.410&partnerID=40&md5=6ed73d36c33eb3183633bf3dae0f3e1d}, doi = {10.1002/jhbp.410}, issn = {18686974}, year = {2017}, date = {2017-01-01}, urldate = {2017-01-01}, journal = {Journal of Hepato-Biliary-Pancreatic Sciences}, volume = {24}, number = {1}, pages = {17 – 23}, publisher = {Blackwell Publishing Asia}, abstract = {Anatomical liver resection with the Glissonean pedicle isolation is widely approved as an essential procedure for safety and curability. Especially, the extrahepatic Glissonean pedicle isolation without parenchymal destruction should be an ideal procedure. However, the surgical technique has not been standardized due to a lack of anatomical understanding. Herein, we proposed a novel comprehensive surgical anatomy of the liver based on Laennec's capsule that would give a theoretical background to the extrahepatic Glissonean pedicle isolation. Laennec's capsule is the proper membrane that covers not only the entire surface of the liver including the bare area but also the intrahepatic parenchyma surrounding the Glissonean pedicles. Consequently, there exists a gap between the Glissonean pedicle and Laennec's capsule that could be reached extrahepatically and allows us to isolate the extrahepatic Glissonean pedicle without parenchymal destruction systematically. For standardization, it is essential to approach the “six gates” indicated by the “four anatomical landmarks”: the Arantius plate, the umbilical plate, the cystic plate and the Glissonean pedicle of the caudate process (G1c). This novel anatomy would contribute to standardize the surgical techniques of the systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection including laparoscopic or robotic liver resection and to bring innovative changes in hepatobiliary surgery for spreading safe and curable liver resection. © 2017 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery.}, note = {Cited by: 105; All Open Access, Green Open Access, Hybrid Gold Open Access}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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Anatomical liver resection with the Glissonean pedicle isolation is widely approved as an essential procedure for safety and curability. Especially, the extrahepatic Glissonean pedicle isolation without parenchymal destruction should be an ideal procedure. However, the surgical technique has not been standardized due to a lack of anatomical understanding. Herein, we proposed a novel comprehensive surgical anatomy of the liver based on Laennec's capsule that would give a theoretical background to the extrahepatic Glissonean pedicle isolation. Laennec's capsule is the proper membrane that covers not only the entire surface of the liver including the bare area but also the intrahepatic parenchyma surrounding the Glissonean pedicles. Consequently, there exists a gap between the Glissonean pedicle and Laennec's capsule that could be reached extrahepatically and allows us to isolate the extrahepatic Glissonean pedicle without parenchymal destruction systematically. For standardization, it is essential to approach the “six gates” indicated by the “four anatomical landmarks”: the Arantius plate, the umbilical plate, the cystic plate and the Glissonean pedicle of the caudate process (G1c). This novel anatomy would contribute to standardize the surgical techniques of the systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection including laparoscopic or robotic liver resection and to bring innovative changes in hepatobiliary surgery for spreading safe and curable liver resection. © 2017 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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• https://www.scopus.com/inward/record.uri?eid=2-s2.0-85011617124&doi=10.1002%[...]
• doi:10.1002/jhbp.410

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2013

Bismuth H

Revisiting liver anatomy and terminology of hepatectomies Journal Article

In: Annals of Surgery, vol. 257, no 3, pp. 383 – 386, 2013, ISSN: 15281140, (Cited by: 63).

Abstract | Links | BibTeX

@article{Bismuth2013383, title = {Revisiting liver anatomy and terminology of hepatectomies}, author = {Henri Bismuth}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84873910931&doi=10.1097%2fSLA.0b013e31827f171f&partnerID=40&md5=ff485d490eb33b4bbf7bbf71e1cf8494}, doi = {10.1097/SLA.0b013e31827f171f}, issn = {15281140}, year = {2013}, date = {2013-01-01}, urldate = {2013-01-01}, journal = {Annals of Surgery}, volume = {257}, number = {3}, pages = {383 – 386}, abstract = {Background:: Since the development of liver surgery, several descriptions of liver anatomical division and hepatectomies have been made, causing some confusion among surgeons. METHODS:: The initial anatomical description according to Couinaud is reviewed and corrected taking into account the descriptions made in the following decades. RESULTS:: It seems that by reviewing the description of the different authors, a precise anatomical division of the liver may be achieved and a simple terminology of hepatectomies may be proposed. CONCLUSIONS:: It is hoped that the proposal of this anatomical description and this terminology of hepatectomies may find a consensus among the liver surgical community from America, Asia, and Europe. © 2013 by Lippincott Williams & Wilkins.}, note = {Cited by: 63}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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Background:: Since the development of liver surgery, several descriptions of liver anatomical division and hepatectomies have been made, causing some confusion among surgeons. METHODS:: The initial anatomical description according to Couinaud is reviewed and corrected taking into account the descriptions made in the following decades. RESULTS:: It seems that by reviewing the description of the different authors, a precise anatomical division of the liver may be achieved and a simple terminology of hepatectomies may be proposed. CONCLUSIONS:: It is hoped that the proposal of this anatomical description and this terminology of hepatectomies may find a consensus among the liver surgical community from America, Asia, and Europe. © 2013 by Lippincott Williams & Wilkins.

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• https://www.scopus.com/inward/record.uri?eid=2-s2.0-84873910931&doi=10.1097%[...]
• doi:10.1097/SLA.0b013e31827f171f

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Fasel J; Schenk A

Concepts for liver segment classification: Neither old ones nor new ones, but a comprehensive one Journal Article

In: Journal of Clinical Imaging Science, vol. 3, no 1, 2013, ISSN: 21565597, (Cited by: 28; All Open Access, Green Open Access, Hybrid Gold Open Access).

Abstract | Links | BibTeX

@article{Fasel2013, title = {Concepts for liver segment classification: Neither old ones nor new ones, but a comprehensive one}, author = {Jean Fasel and Andrea Schenk}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84893389828&doi=10.4103%2f2156-7514.120803&partnerID=40&md5=d1b58a425827fe362470cac457a2e657}, doi = {10.4103/2156-7514.120803}, issn = {21565597}, year = {2013}, date = {2013-01-01}, urldate = {2013-01-01}, journal = {Journal of Clinical Imaging Science}, volume = {3}, number = {1}, abstract = {Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice. Despite Couinaud′s widely used eight-segments scheme, opinions on the issue differ considerably between authors. The aim of this article is to illustrate the scientific basis for understanding and harmonizing inconsistencies between seemingly contradictory observations. Possible clinical implications are addressed.}, note = {Cited by: 28; All Open Access, Green Open Access, Hybrid Gold Open Access}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice. Despite Couinaud′s widely used eight-segments scheme, opinions on the issue differ considerably between authors. The aim of this article is to illustrate the scientific basis for understanding and harmonizing inconsistencies between seemingly contradictory observations. Possible clinical implications are addressed.

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• doi:10.4103/2156-7514.120803

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2005

Strasberg S M

Nomenclature of hepatic anatomy and resections: A review of the Brisbane 2000 system Journal Article

In: Journal of Hepato-Biliary-Pancreatic Surgery, vol. 12, no 5, pp. 351 – 355, 2005, ISSN: 09441166, (Cited by: 598).

Abstract | Links | BibTeX

@article{Strasberg2005351, title = {Nomenclature of hepatic anatomy and resections: A review of the Brisbane 2000 system}, author = {Steven M. Strasberg}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-27944465366&doi=10.1007%2fs00534-005-0999-7&partnerID=40&md5=40e30476f1199aa456d45f17063fe258}, doi = {10.1007/s00534-005-0999-7}, issn = {09441166}, year = {2005}, date = {2005-01-01}, urldate = {2005-01-01}, journal = {Journal of Hepato-Biliary-Pancreatic Surgery}, volume = {12}, number = {5}, pages = {351 – 355}, abstract = {The Brisbane 2000 system of nomenclature of hepatic anatomy and resections was introduced to provide a universal terminology in an area that was plagued by confusing and inappropriate terminology. The article describes historical developments central to the emergence of the new terminology and describes the terminology, its attributes, and rules of application. © Springer-Verlag Tokyo 2005.}, note = {Cited by: 598}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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The Brisbane 2000 system of nomenclature of hepatic anatomy and resections was introduced to provide a universal terminology in an area that was plagued by confusing and inappropriate terminology. The article describes historical developments central to the emergence of the new terminology and describes the terminology, its attributes, and rules of application. © Springer-Verlag Tokyo 2005.

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• doi:10.1007/s00534-005-0999-7

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2000

Strasberg S M; Belghiti J; Clavien P -A; Gadzijev E; Garden J O; Lau W -Y; Makuuchi M; Strong R W

The Brisbane 2000 Terminology of Liver Anatomy and Resections Journal Article

In: HPB, vol. 2, no 3, pp. 333-339, 2000, ISSN: 1365-182X.

Abstract | Links | BibTeX

@article{2000333, title = {The Brisbane 2000 Terminology of Liver Anatomy and Resections}, author = {S. M. Strasberg and J. Belghiti and P. -A. Clavien and E. Gadzijev and J. O. Garden and W. -Y. Lau and M. Makuuchi and R. W. Strong}, url = {https://www.sciencedirect.com/science/article/pii/S1365182X17307554}, doi = {https://doi.org/10.1016/S1365-182X(17)30755-4}, issn = {1365-182X}, year = {2000}, date = {2000-01-01}, urldate = {2000-01-01}, journal = {HPB}, volume = {2}, number = {3}, pages = {333-339}, abstract = {Background The Scientific Committee of the IHPBA, meeting in December 1998, created a Terminology Committee to deal with the confusion in nomenclature of hepatic anatomy and liver resections. A terminology was sought which was anatomically correct, in which anatomical and surgical terms agreed, and which was consistent, self-explanatory, linguistically correct, translatable, precise and concise. Discussion After 18 months the International Committee presented a terminology that was accepted by the IHPBA at the recent World Congress in Brisbane. The purpose of this paper is to present that terminology.}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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Background The Scientific Committee of the IHPBA, meeting in December 1998, created a Terminology Committee to deal with the confusion in nomenclature of hepatic anatomy and liver resections. A terminology was sought which was anatomically correct, in which anatomical and surgical terms agreed, and which was consistent, self-explanatory, linguistically correct, translatable, precise and concise. Discussion After 18 months the International Committee presented a terminology that was accepted by the IHPBA at the recent World Congress in Brisbane. The purpose of this paper is to present that terminology.

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• https://www.sciencedirect.com/science/article/pii/S1365182X17307554
• doi:https://doi.org/10.1016/S1365-182X(17)30755-4

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1982

Bismuth H

Surgical anatomy and anatomical surgery of the liver Journal Article

In: World Journal of Surgery, vol. 6, no 1, pp. 3 – 9, 1982, ISSN: 14322323, (Cited by: 604).

Abstract | Links | BibTeX

@article{Bismuth19823, title = {Surgical anatomy and anatomical surgery of the liver}, author = {Henri Bismuth}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-0020328518&doi=10.1007%2fBF01656368&partnerID=40&md5=a167ed853588202ea3a324c9838386e5}, doi = {10.1007/BF01656368}, issn = {14322323}, year = {1982}, date = {1982-01-01}, urldate = {1982-01-01}, journal = {World Journal of Surgery}, volume = {6}, number = {1}, pages = {3 – 9}, publisher = {Springer-Verlag}, abstract = {The morphologic anatomy of the liver is described as 2 main and 2 accessory lobes. The more recent functional anatomy of the liver is based on the distribution of the portal pedicles and the location of the hepatic veins. The liver is divided into 4 sectors, some of them composed of 2 segments. In all, there are 8 segments. According to the anatomy, typical hepatectomies (or "réglées") are those which are performed along anatomical scissurae. The 2 main technical conceptions of typical hepatectomies are those with preliminary vascular control (Lortat-Jacob's technique) and hepatectomies with primary parenchymatous transection (Ton That Tung's technique). A good knowledge of the anatomy of the liver is a prerequisite for anatomical surgery of this organ. © 1982 Société Internationale de Chirurgie.}, note = {Cited by: 604}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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The morphologic anatomy of the liver is described as 2 main and 2 accessory lobes. The more recent functional anatomy of the liver is based on the distribution of the portal pedicles and the location of the hepatic veins. The liver is divided into 4 sectors, some of them composed of 2 segments. In all, there are 8 segments. According to the anatomy, typical hepatectomies (or "réglées") are those which are performed along anatomical scissurae. The 2 main technical conceptions of typical hepatectomies are those with preliminary vascular control (Lortat-Jacob's technique) and hepatectomies with primary parenchymatous transection (Ton That Tung's technique). A good knowledge of the anatomy of the liver is a prerequisite for anatomical surgery of this organ. © 1982 Société Internationale de Chirurgie.

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• doi:10.1007/BF01656368

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1891

Hartmann H A

Quelques points de l’anatomie et de la chirurgie des voies biliaires. Journal Article

In: Bulletin de la Société anatomique de Paris, vol. 5 sér., iss. 5, pp. 480-500, 1891.

BibTeX

@article{Hartmann1891, title = {Quelques points de l’anatomie et de la chirurgie des voies biliaires.}, author = {Henri Albert Hartmann}, year = {1891}, date = {1891-01-01}, urldate = {1891-01-01}, journal = {Bulletin de la Société anatomique de Paris}, volume = {5 sér.}, issue = {5}, pages = {480-500}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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1888

Rex H

Beitrage zur Morphologie der Saugerleber Journal Article

In: Morphol. Jahrb., vol. 14, pp. 517, 1888.

BibTeX

@article{nokey, title = {Beitrage zur Morphologie der Saugerleber}, author = {Hugo Rex}, year = {1888}, date = {1888-01-01}, urldate = {1888-01-01}, journal = {Morphol. Jahrb.}, volume = {14}, pages = {517}, keywords = {}, pubstate = {published}, tppubtype = {article} }

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L'anatomia del Fegato

La descrizione anatomica del fegato Vai

Le resezioni epatiche

Vai

Storia della Chirurgia Epatica

L'evoluzione della conoscenza chirurgica sul fegato Vai

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Gli studi scientifici della Chirurgia del Fegato

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