A hemangioma was found on the left of the falciform ligament of the liver. Surgeon dissecting Couinaud’s segments of the liver to the left of the attachment of the falciform ligament resects which lobes?
a. Chuinard divided liver into various segments based upon the distribution of portal and hepatic veins.
b. Resection of liver is either anatomical or non-anatomical
c. Non-anatomical resections are minor and don’t follow Couinaud’s segmentation.
d. Major removals follow the Couinaud’s classification for putting the lines of resection.
e. The intersegmental hepatic veins serve as a surgical landmark (as do the pulmonary veins in the lungs-they are also Segment II and III lie to the left of the falciform ligament and will be resected in this patient intersegmental in distribution).
f. These hepatic veins provide surgical planes to dissect the liver, but also are a major source of bleeding, which the surgeon has to bear with.
g. Caudate (comma shapeD. lobe is the beginning of the segmental nomenclature and is taken as segment - I (posterior segment).
h. Quadrate lobe is considered under left medial segment and is numbered segment -IV.
i. Note: Segments are numbered in anti-clockwise direction when Liver is visualized in posterior view.
ii. Except for the caudate lobe (segment I), the liver is divided into right and left livers based on the primary (1 degreE. division of the portal triad into right and left branches.
iii. The plane between the right and left livers being the main portal fissure in which the middle hepatic vein lies.
iv. Healy and Schroy segmentation is also followed widely, where arterial and biliary tree is the reference.