Right Paramedian Sector

Terminology Committee of the International Hepato-Pancreato-Biliary Association: SM Strasberg (USA), J Belghiti (France), P-A Clavien (Switzerland), E Gadzijev (Slovenia), JO Garden (UK), W-Y Lau (China), M Makuuchi (Japan), and RW Strong (Australia). The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB 2:333-339,2000

Anatomical Couinaud segments Term referred to

Right Hemiliver OR Right Liver

Left Hemiliver

Left Liver

Term for surgical resection

Right Hepatectomy OR

Right Hemihepatectomy (stipulate +/-segment 1)

Left Hepatectomy OR

Left Hemihepatectomy (stipulate +/-segment 1)

Diagram (pertinent area is shaded)

Right Hepatectomy OR

Right Hemihepatectomy (stipulate +/-segment 1)

Left Hepatectomy OR

Left Hemihepatectomy (stipulate +/-segment 1)

Right Hepatectomy

Border or watershed: The border or watershed of the first order division which separates the two hemilivers is a plane which intersects the gallbladder fossa and the fossa for the IVC and is called the "midplane of the liver".

Fig 1. Nomenclature for first order division anatomy and resections

Anatomical Couinaud segments Term referred to

Term for surgical resection

Diagram

(pertinent area is shaded)

Anterior Section the anatomical terms an in

Right anterior sectionectomy

Right Sg 6,7 Right

Posterior Section posterior sectionectomy

Left Sg 4 Left medial sectionectomy

Medial Section OR

Resection segment 4 (also see Third order)

Segmentectomy 4 (also see Third order)

Right Anterior Sectionectomy

Left Sg 2,3 Left lateral sectionectomy

Lateral Section OR

Bisegmentectomy 2,3 (also see Third order)

Extended Right Hepatectomy

Other "sectional liver resections

Sg4-8 Right Trisectionectomy

Extended Right Hepatectomy or

Extended Right Hemihepatectomy (stipulate +/-segment 1)

Sg 2, 3, 4, 5, 8 Left Trisectionectomy

Extended Left Hepatectomy or

Extended Left Hemihepatectomy (stipulate +/-segment 1)

Liver Trisectionectomy

Border or watershed: The borders or watersheds of the sections are planes referred to as the right and left intersectional planes. The left intersectional plane passes through the umbilical fissure and the attachment of the falciform ligament. There is no surface marking of the right intersectional plane.

Fig 2. Nomenclature for second order division anatomy and resections, based on bile ducts and hepatic artery

Anatomical Couinaud segments Term for

Term referred to surgical resection

Diagram

(pertinent area is shaded)

Segments 1-9 Any one of

Segmentectomy (e.g. segmentectomy 6)

Liver Segmentectomy

2 contiguous Any two ofSg 1 to Sg 9 Bisegmentectomy sements in continuity (e.g. bisegmentectomy 5,6)

Bisegmentectomy

For clarity Sg.1 and 9 are not shown. It is also acceptable to refer to ANY resection by its third-order segments, eg. right hemihepatectomy can also be called resection Sg 5-8.

Border or watershed: The borders or watersheds of the segments are planes referred to as interseg-mental planes.

Fig 3. Nomenclature for third order division anatomy and resections

Anatomical Couinaud segments Term referred to

Term for surgical resection

Diagram

(pertinent area is shaded)

Right Anterior Sector

Right paramedian Sector

Right Posterior Sector

Right lateral Sector

Left Sg 3,4

Medial Sector OR

Left

Paramedian Sector

Left Sg 2

Lateral Sector

Left Posterior Sector

Add (-ectomy) to any of the anatomical terms as in Right anterior sectorectomy OR

Right paramedian sectorectomy

Right posterior sectorectomy OR

Right lateral sectorectomy

Left medial sectorectomy OR

Left paramedian sectorectomy

Bisegmentectomy 3,4

Left lateral sectorectomy

Left posterior sectorectomy

Segmentectomy 2

Add (-ectomy) to any of the anatomical terms as in Right anterior sectorectomy OR

Right paramedian sectorectomy

Left medial sectorectomy OR

Left paramedian sectorectomy

Bisegmentectomy 3,4

Right Anterior Sectionectomy

Right anterior sector and Right anterior section are synonyms. Right posterior sector and Right posterior section are synonyms. Left medial sector and Left medial section are NOT synonyms and are NOT exchangeable terms. They do not describe the same anatomic areas. Left lateral sector and Left lateral section are also NOT synonyms and are NOT exchangeable terms.

Border or watershed: The borders or watersheds of second-order division based on PV are called right and left intersectoral planes. These have no surface markings.

Fig 4. (Addendum) Nomenclature for alternative second order division, based on portal vein

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