Anatomic basis of segmental hepatectomy The eight anatomic segments of the liver are dened by the distribution of the

hepatic and portal venous systems. Each liver segment has an independent biliary drainage and vascular inow and outow (Fig.1A !". #onse$uently it is possible to remove an individual segment without disrupting the blood ow or biliary drainage of the remaining segments. !ased on the !risbane %&&& Terminology of 'epatic Anatomy and (esection (Table 1" the liver can be divided into four sections) the right anterior section (segments * and *+++" right posterior section (segments *+ and *++" left medial section (segment +*" and left lateral section (segments ++ and +++" ,-.. The brous sheath of /lisson encircles the hepatic artery portal vein and bile duct at the hilum and continues as the liver capsule. The right sectional pedicles of the liver are surgically accessible at the hilum by the posterior intrahepatic /lissonian approach described by 0aunois and 1amieson ,2 1&.. 3edicle ligation allows inow control before parenchymal transection. 4elective clamping of a pedicle demarcates the liver segment or liver section of interest and guides the plane of resection. 5n occasion control of the inow pedicle is not recommended. For instance in the presence of portal hypertension with associated collaterals or previous right upper $uadrant abdominal surgery dissection at the hilum may be ha6ardous ,11.. +n these cases the segmental boundary is estimated directly or with the use of intraoperative ultrasonography. 5thers advocate the dye in7ection mapping techni$ue as described by 8a9uuchi ,1%.. The ma7or outow vessels of the liver are the right middle and left hepatic veins. They are generally accessible outside the liver where they enter the inferior vena cava (+*#". Early control of the hepatic veins minimi6es intraoperative blood loss. The presence of a large inferior accessory vein to the right liver or a well:developed umbilical vein to the left liver provides additional e;ibility in performing segment:oriented resection because they provide alternative venous drainage in the event that the right or middle hepatic veins respectively need to be sacriced.

3embagian segmen hepar 'epar dibagi oleh delapan segmen berdasar9an distribusi hati dan sistem vena 3ortal . 4etiap segmen hati memili9i drainase bilier tersendiri serta inflow dan outflow vas9ular ( /ambar " . 'al ini memung9in9an untu9 dapat menghapus salah satu segmen individu tanpa mengganggu aliran darah atau drainase empedu dari segmen yang tersisa. !erdasar9an !risbane tahun %&&& dalam bu9unya terminologi anatomi dan rese9si hepati9 hati dapat dibagi men7adi empat bagian ) bagian anterior 9anan ( segmen * dan *+++ " bagian posterior 9anan ( segmen *+ dan *++ " bagian medial ( segmen +* " dan bagian 9iri lateral ( segmen ++ dan +++ ".

,-. Terminology #ommittee of the +nternational 'epato:3ancreato:!iliary Association. +'3!A !risbane %&&& Terminology of 0iver Anatomy < (esections. 'epato:3ancrea to !iliary Association %&&=>%(=")===?2. Available at) www.ihpba.org. (0iver (esection /uidelines".