Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry

Jill P. J. M. Hikspoors, Mathijs M. J. P. Peeters, Nutmethee Kruepunga, Hayelom K. Mekonen, Greet M. C. Mommen, S. Eleonore Kohler, Wouter H. Lamers*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular physiology on hepatic venous development. Human embryonic livers (5-10 weeks of development) were visualized with Amira 3D-reconstruction and Cinema 4D-remodeling software. Starting at 5 weeks, the portal and umbilical veins sprouted portal-vein branches that, at 6.5 weeks, had been pruned to 3 main branches in the right hemi-liver, whereas all (>10) persisted in the left hemi-liver. The asymmetric branching pattern of the umbilical vein resembled that of a "distributing" vessel, whereas the more symmetric branching of the portal trunk resembled a "delivering" vessel. At 6 weeks, 3-4 main hepatic-vein outlets drained into the inferior caval vein, of which that draining the caudate lobe formed the intrahepatic portion of the caval vein. More peripherally, 5-6 major tributaries drained both dorsolateral regions and the left and right ventromedial regions, implying a "crypto-lobar" distribution. Lobar boundaries, even in non-lobated human livers, and functional vascular requirements account for the predictable topography and branching pattern of the liver veins, respectively.

Original languageEnglish
Article number17109
Number of pages12
JournalScientific Reports
Volume7
DOIs
Publication statusPublished - 7 Dec 2017

Keywords

  • COMPUTED-TOMOGRAPHY
  • SURGICAL ANATOMY
  • VENOUS DRAINAGE
  • HUMAN EMBRYOS
  • CAUDATE LOBE
  • ORGANOGENESIS
  • TERMINOLOGY
  • RESECTIONS
  • SURGERY
  • CT

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