Hepatic Segmental Anatomy: Couinaud Resection Planner |…

What are Hepatic Segments?

The human liver is divided into eight anatomical sections known as Couinaud segments, named I through VIII. Each segment has its own blood supply from the portal vein and hepatic artery, and drains into specific branches of the hepatic veins.

These segments are defined by their vascular supply and biliary drainage, making them essential for surgical planning to avoid complications such as bile leakage or liver failure.

Why is Couinaud Segmental Anatomy Important?

Couinaud segments provide a standardized method of describing the liver’s structure, which is crucial for surgeons performing hepatic resections. By understanding these segments, doctors can plan the safest and most effective surgical approach.

Knowledge of segmental anatomy helps in predicting the future liver remnant (FLR) after resection, ensuring that enough healthy liver tissue remains to support the patient post-surgery.

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How Does Couinaud Segmental Anatomy Work?

Couinaud segments are based on the arterial and venous supply of the liver. The portal vein branches into left and right branches, each supplying a lobe of the liver. The hepatic artery also divides into two main branches that supply both lobes.

Each segment is further subdivided by the hepatic veins, which drain blood from specific areas of the liver. This segmentation allows for precise identification and isolation of liver tissue during surgery.

Applications in Surgery

Couinaud segments are particularly useful in planning resections for hepatocellular carcinoma (HCC) or metastatic disease, where it is critical to preserve as much healthy liver tissue as possible.

By understanding the vascular and biliary anatomy of each segment, surgeons can tailor their approach to maximize FLR while minimizing risk.

Frequently asked questions

How does Couinaud segmentation differ from other liver segmentations?

Couinaud segmentation is based on both the arterial and venous supply of the liver, providing a more detailed anatomical description compared to simpler segmentations that only consider the portal vein.

What are the risks if the future liver remnant is not adequately preserved during surgery?

If too much healthy liver tissue is removed, it can lead to liver failure or other complications such as jaundice and coagulopathy. Preserving a sufficient FLR is critical for patient survival.

Can Couinaud segments be used in non-surgical procedures?

While primarily used in surgical planning, knowledge of Couinaud segments can also aid in interventional radiology and other non-surgical procedures involving the liver.

How is the Future Liver Remnant percentage calculated?

The FLR percentage is calculated based on the volume of the remaining healthy liver tissue after resection. It is a key factor in determining whether a patient can safely undergo surgery.

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