Dr MHA Bemelmans,
ESCAM (European Surgical Center Aachen Maastricht)
Surgical Anatomy of the liver
Uniklinik RWTH Aachen
Uniklinik
RWTH Aachen
ESCAM
Disclosures
Uniklinik RWTH Aachen ESCAM
Potential conflict of interest None
Potentially relevant company relationships in
connection with event
None
Uniklinik RWTH Aachen ESCAM
Marc
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
The cell lineage steps during hepatic development (red) from
uncommitted endoderm to functional adult hepatocytes and
biliary epithelium
Time line mouse liver development
Uniklinik RWTH Aachen ESCAM
Adult liver
Uniklinik RWTH Aachen ESCAM
Galen (circa 130–200 BC) was one of the
first who described the liver. He thought that
the liver was five-lobed. Such opinion
dominated until the 15th century.
Uniklinik RWTH Aachen ESCAM
Vesalius founder modern anatomy (1514-1564)
Uniklinik RWTH Aachen ESCAM
1st book on human anatomy Vesalius
Uniklinik RWTH Aachen ESCAM
In 1654, F. Glisson (1597–1677) studied the
liver. He discussed topography of the
intrahepatic vessels and surrounding
connective tissue. Even today this is
referred to as Glisson’s capsule and the triad
(portal vein, biliary duct and hepatic artery)
is called portal pedicle or Glisson’s pedicle
Uniklinik RWTH Aachen ESCAM
Francois Glisson
Uniklinik RWTH Aachen ESCAM
1597-1677
N. A. Goldsmith and R. T. Woodburne
supported division of the liver into four
segments, each having two subsegments
with second order of portal vein branches
(1957)
Uniklinik RWTH Aachen ESCAM
C. Couinaud suggested that the liver should
be divided into eight segments, based on
third order portal vein distribution (1957)
Uniklinik RWTH Aachen ESCAM
Claude Couinaud
Uniklinik RWTH Aachen ESCAM
A good knowledge of the anatomy
is a prerequisite for modern surgery
of the liver.”
H. Bismuth
Uniklinik RWTH Aachen ESCAM
Henri Bismuth
Uniklinik RWTH Aachen ESCAM
Porto Allegre Brasil 2016
Uniklinik RWTH Aachen ESCAM
Bismuth’s classification. H. Bismuth brought
together the Couinaud’s cadaveric system in
situ and the system of Goldsmith and
Woodburn in vivo
Uniklinik RWTH Aachen ESCAM
He distinguished three planes (scissurae),
hosting the hepatic veins and a transverse
plane passing through the right and left
portal branches. Additionally, H. Bismuth
described the caudate lobe as a separate
segment I.
Uniklinik RWTH Aachen ESCAM
Anatomy according to Bismuth
Uniklinik RWTH Aachen ESCAM
Anatomy 1
Uniklinik RWTH Aachen ESCAM
Anatomy 2
Uniklinik RWTH Aachen ESCAM
Anatomy 3
Uniklinik RWTH Aachen ESCAM
Anatomy 4
Uniklinik RWTH Aachen ESCAM
Anatomy 5
Uniklinik RWTH Aachen ESCAM
Anatomy 6
Uniklinik RWTH Aachen ESCAM
Anatomy 7
Uniklinik RWTH Aachen ESCAM
Anatomy 9
Uniklinik RWTH Aachen ESCAM
VIDEO???
Uniklinik RWTH Aachen ESCAM
Cirrhosis
Uniklinik RWTH Aachen ESCAM
Anatomy 10
Uniklinik RWTH Aachen ESCAM
No comment
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Arterial anatomy
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Portal Anatomy
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Biliary Anatomy
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Anatomy 11
Uniklinik RWTH Aachen ESCAM
Anatomy 12
Uniklinik RWTH Aachen ESCAM
Anatomy 13
Uniklinik RWTH Aachen ESCAM
Anatomy 14
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Majno et all j Hepatol 2014
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM
Uniklinik RWTH Aachen ESCAM