Anterior fissure of the right liver--the third door of the liver.
OBJECTIVE
Although the anterior segment of the liver has been divided into segments 8 and 5, we have, during surgical or interventional procedures, occasionally encountered patients in whom the right anterior portal vein does not bifurcate into the superior and inferior branches. Thus, the in vivo anatomy of the right liver was reevaluated to clarify the segmental anatomy.


METHODS
We evaluated the hepatic venous and portal ramification patterns, using three-dimensional images reconstructed from computed tomography. In addition, liver volumetry was performed.


RESULTS
All branches arising from the anterior trunk were divided into two groups: the right ventral portal branches (RVP) and the right dorsal portal branches (RDP), and the anterior fissure vein crossed between the RVP and RDP. The ventral and dorsal regions of the anterior segment were approximately equal from a volumetric point of view.


CONCLUSIONS
The anterior segment seems to be divided into the ventral and dorsal segments by the anterior fissure, and we propose a reclassification of the right liver that divides the right liver into three segments. Dissection of the parenchyma along the anterior fissure makes the third door of the liver open, resulting in the exposing of all Glissonian pedicles of the right liver. The introduction of our segmental anatomy and surgical procedure will allow more systematic and limited liver resections.
Cho
Akihiro
A
Department of Surgery, Seirei Sakura Hospital, 2-36-2 Ebaradai, Sakura, Chiba 285-8765, Japan.
Okazumi
Shinichi
S
Makino
Harufumi
H
Miura
Fumihiko
F
Shuto
Kiyohiko
K
Mochiduki
Ryouyu
R
Tohma
Takayuki
T
Kudo
Hidehiro
H
Matsubara
Katsuhiko
K
Gunji
Hisashi
H
Yamamoto
Hiroshi
H
Ryu
Munemasa
M
Ochiai
Takenori
T
D003196:Computer Graphics; D004210:Dissection; D006503:Hepatic Veins / Q000033:anatomy & histology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology* / Q000098:blood supply / Q000000981:diagnostic imaging; D011169:Portal Vein / Q000033:anatomy & histology; D011172:Portography; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography