Question

Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections. J Hepatol. 2014 Mar;60(3):654-62.

Answer 1

Depending on the purpose for which the description is needed, there are three various levels of complexity at which the vascular architecture of the liver might be described:

• The first level, known as the conventional level, is equivalent to Couinaud's classic 8-segment scheme and serves as a common language for doctors from other disciplines to define the location of localized hepatic lesions.
• The true branching of the hepatic veins and the main portal pedicles is taken into consideration in the second, surgical level, which will be used for anatomical liver resections and transplantations. Modern surgical and radiological procedures may fully exploit this anatomy, but doing so involves acknowledging that the Couinaud scheme is oversimplified and examining the vascular architecture objectively.
• The third degree of complexity, known as the academic level, is focused on the anatomist and the requirement to provide a systematization that clarifies the apparent conflicts between anatomical literature, radiological imaging, and surgical practice.

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