One discussion this week involved hepatic resections.

Reference: Strasberg SM, et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2(3):333-339.

Summary: The images below are taken from Table 2 and the Addendum in the referenced article.

Table 2. Second-order division (p. 337).

Addendum. Alternative second-order division (second-order division based on portal vein) (p.338).

The authors state that terminology be consistent and based on internal anatomy:

“The watersheds of the hepatic artery, bile duct and portal vein are identical except for the second-order division of these structures on the left side of the liver. The arterial and biliary watersheds divide the left side of the liver through the umbilical fissure. All anatomists, including Couinaud and Healey, agree on this point. The portal vein watershed divides the left side of the liver through the plane between segments 2 and 3 (Couinaud). Since both modes of division of the left side of the liver are currently accepted as anatomically correct, two terminologies are required for the second-order division of the liver” (p.334).