Skip to main content
SpringerLink
Log in

Cantlie’s Plane in Major Variations of the Primary Portal Vein Ramification at the Porta Hepatis: Cutting Experiment using Cadaveric Livers

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Major variations of the primary portal vein ramifications at the porta hepatis, such as trifurcation or an anterior sectorial trunk originating from the left portal vein (L+A pattern), seem to be relatively common morphologic features, with an incidence of 10% to 30%. However, it has not been clearly demonstrated whether the usual landmarks of Cantlie’s line and the middle hepatic vein (MHV) are reliable indicators of the border between the right and left liver when these variations are present. We searched for any discrepancies between the actual left/right territorial border of the intrahepatic portal vein and the usual position of Cantlie’s line or the MHV course using 30 fixed cadaveric livers with major variations including hilar trifurcation and the L+A pattern. In most livers (63.3%) the usual transection plane for left/right hepatectomy was occupied by Couinaud’s segment VIII (S8), and the territory of the right portal vein extended to the left of Cantlie’s plane. The MHV course did not correspond with the actual border between the right and left liver. Significant rightward shift of the MHV occurred in 76.9% of livers. The severity of the discrepancy seemed to depend on the distance between the origins of the anterior and posterior sectorial trunks along the main portal vein. In conclusion, variations of the primary portal ramifications alter the segmental configurations of the liver. Our results evoke doubt over the reliability of Cantlie’s line and the MHV course as landmarks for major hepatectomy when such variations are present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. T Inoue H Kinoshita K Hirohashi et al. (1986) ArticleTitleRamification of the intrahepatic portal vein identified by percutaneous transhepatic portography World J. Surg. 10 287–293 Occurrence Handle1:STN:280:BimB3M%2FivF0%3D Occurrence Handle3705610

    CAS  PubMed  Google Scholar 

  2. JR Ortale CH Naves De Freitas Azevedo C Mello De Castro (2000) ArticleTitleAnatomy of the intrahepatic ramification of the portal vein in the right hemiliver Cells Tissues Organs 166 378–387 Occurrence Handle10.1159/000016754 Occurrence Handle1:STN:280:DC%2BD3cvjsFWhsA%3D%3D Occurrence Handle10867440

    Article  CAS  PubMed  Google Scholar 

  3. T Yamane K Mori K Sakamoto et al. (1988) ArticleTitleIntrahepatic ramification of the portal vein in the right and caudate lobes of the liver Acta Anat. (Basel). 133 162–172 Occurrence Handle1:STN:280:BiaC3c3jvV0%3D

    CAS  Google Scholar 

  4. P Soyer DA Bluemke MA Choti et al. (1995) ArticleTitleVariations in the intrahepatic portions of the hepatic and portal veins AJR. Am. J. Roentgenol. 164 103–108 Occurrence Handle1:STN:280:ByqD1M7hs1I%3D Occurrence Handle7998521

    CAS  PubMed  Google Scholar 

  5. YF Cheng TL Huang CL Chen et al. (1997) ArticleTitleAnatomic dissociation between the intrahepatic bile duct and portal vein World J. Surg. 21 297–300 Occurrence Handle10.1007/s002689900232 Occurrence Handle1:STN:280:ByiC28fptVw%3D Occurrence Handle9015174

    Article  CAS  PubMed  Google Scholar 

  6. K Yamamoto (1987) ArticleTitleHepatic segment: a study from a vascular architectural point of view Kanzo 28 949–961

    Google Scholar 

  7. MS Leeuwen ParticleVan J Noordzij MA Fernandez et al. (1994) ArticleTitlePortal venous and segmental anatomy of the right hemiliver: observations based on three-dimensional spiral CT renderings AJR. Am. J. Roentgenol. 163 1395–1404 Occurrence Handle7992736

    PubMed  Google Scholar 

  8. J Cantlie (1898) ArticleTitleOn a new arrangement of the right and left lobes of the liver J. Anat. Physiol. Lond 32 iv

    Google Scholar 

  9. C Couinaud (1989) Surgical Anatomy of the Liver Revisited Claude Couinaud Paris

    Google Scholar 

  10. NA Goldsmith RT Woodburne (1957) ArticleTitleThe surgical anatomy pertaining to liver resection Surg. Gynecol. Obstet. 105 310–318 Occurrence Handle1:STN:280:CyeD3M%2FjtlY%3D Occurrence Handle13467662

    CAS  PubMed  Google Scholar 

  11. MF Chen TL Hwang CF Hung (1991) ArticleTitleHuman liver regeneration after major hepatectomy: a study of liver volume by computed tomography Ann. Surg. 213 227–229 Occurrence Handle1:STN:280:By6C2M7hsFE%3D Occurrence Handle1998403

    CAS  PubMed  Google Scholar 

  12. H Bismuth (1988) Surgical anatomy and anatomical surgery of the liver LH Blumgart (Eds) Surgery of the Liver and Biliary Tract Churchill Livingstone Edinburg 3–9

    Google Scholar 

  13. LH Blumgart (1988) Liver resection-liver and biliary tumors LH Blumgart (Eds) Surgery of the Liver and Biliary Tract Churchill Livingstone Edinburgh 1251–1280

    Google Scholar 

  14. D Azoulay D Castaing A Smail et al. (2000) ArticleTitleResection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization Ann. Surg. 231 480–486 Occurrence Handle10.1097/00000658-200004000-00005 Occurrence Handle1:STN:280:DC%2BD3c3htlaisw%3D%3D Occurrence Handle10749607

    Article  CAS  PubMed  Google Scholar 

  15. S Kawasaki M Makuuchi M Matsynami et al. (1993) ArticleTitlePreoperative measurement of segmental liver volume of donors for living related liver transplantation Hepatology 18 1115–1120 Occurrence Handle1:STN:280:ByuD2c7hvFE%3D Occurrence Handle8225216

    CAS  PubMed  Google Scholar 

  16. Y Inomata S Uemoto K Asonuma et al. (2000) ArticleTitleRight lobe graft in living donor liver transplantation Transplantation 69 258–264 Occurrence Handle1:STN:280:DC%2BD3c7jsVSqtA%3D%3D Occurrence Handle10670636

    CAS  PubMed  Google Scholar 

  17. A Marcos RA Fisher JM Ham et al. (1999) ArticleTitleRight lobe living donor liver transplantation Transplantation 68 798–803 Occurrence Handle1:STN:280:DyaK1MvktlCjsQ%3D%3D Occurrence Handle10515380

    CAS  PubMed  Google Scholar 

  18. ST Fan CM Lo CL Liu (2000) ArticleTitleTechnical refinement in adult-to-adult living donor liver transplantation using right lobe graft Ann. Surg. 231 126–131 Occurrence Handle10.1097/00000658-200001000-00018 Occurrence Handle1:STN:280:DC%2BD3c7gtVSltQ%3D%3D Occurrence Handle10636112

    Article  CAS  PubMed  Google Scholar 

  19. HP Grewal MH Shokouh-Amiri S Vera et al. (2001) ArticleTitleSurgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction Ann. Surg. 233 502–508 Occurrence Handle10.1097/00000658-200104000-00004 Occurrence Handle1:STN:280:DC%2BD3M3kvVajsg%3D%3D Occurrence Handle11303131

    Article  CAS  PubMed  Google Scholar 

  20. D Azoulay D Castaing J Krissat et al. (2000) ArticleTitlePercutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver Ann. Surg. 232 665–672 Occurrence Handle10.1097/00000658-200011000-00008 Occurrence Handle1:STN:280:DC%2BD3crhtF2qsQ%3D%3D Occurrence Handle11066138

    Article  CAS  PubMed  Google Scholar 

  21. JA Goss H Yersiz CR Shackleton et al. (1997) ArticleTitleIn situ splitting of the cadaveric liver for transplantation Transplantation 64 871–877

    Google Scholar 

  22. J Belghiti OA Guevara R Noun et al. (2001) ArticleTitleLiver hanging maneuver: a safe approach to right hepatectomy without liver mobilization J. Am. Coll. Surg. 193 109–111 Occurrence Handle10.1016/S1072-7515(01)00909-7 Occurrence Handle1:STN:280:DC%2BD3MzovValsg%3D%3D Occurrence Handle11442247

    Article  CAS  PubMed  Google Scholar 

  23. CM Coibaud (1985) ArticleTitleA simplified method for controlled left hepatectomy Surgery 97 358–361 Occurrence Handle3975857

    PubMed  Google Scholar 

  24. S Kitagawa G Murakami F Hata et al. (2000) ArticleTitleConfiguration of the right portion of the caudate lobe with special reference to identification of its right margin Clin. Anat. 13 321–340 Occurrence Handle10.1002/1098-2353(2000)13:5<321::AID-CA2>3.0.CO;2-R Occurrence Handle1:STN:280:DC%2BD3M%2FhtVSltw%3D%3D Occurrence Handle10982992

    Article  CAS  PubMed  Google Scholar 

  25. K Kogure H Kuwano N Fujimaki et al. (2000) ArticleTitleRelation among portal segmentation, proper hepatic vein, and external notch of the caudate lobe in the human liver Ann. Surg. 231 223–228 Occurrence Handle10.1097/00000658-200002000-00011 Occurrence Handle1:STN:280:DC%2BD3c7jslSkuw%3D%3D Occurrence Handle10674614

    Article  CAS  PubMed  Google Scholar 

  26. T Kanamura G Murakami S Ko et al. (2003) ArticleTitleEvaluation of the hilar bifurcation territory in the human liver caudate lobe provides critical information to delimit reliable margins for types of various caudate lobe surgery: an anatomical study using livers with and without the external caudate notch World J. Surg. 27 284–288 Occurrence Handle10.1007/s00268-002-6590-3 Occurrence Handle12607052

    Article  PubMed  Google Scholar 

  27. Y Nagaoka S Miyamoto G Murakami et al. (2001) ArticleTitleConfiguration of the liver segment observed in the frontal section including the origin of the left portal trunk at the hepatic hilum Kaibougaku Zassi 76 223–232 Occurrence Handle1:STN:280:DC%2BD3MzjtVKjtA%3D%3D

    CAS  Google Scholar 

  28. K Urata S Kawasaki H Matsunami et al. (1995) ArticleTitleCalculation of child and adult standard liver volume for liver transplantation Hepatology 21 1317–1321 Occurrence Handle1:STN:280:ByqB2MrotVU%3D Occurrence Handle7737637

    CAS  PubMed  Google Scholar 

  29. T Kiuchi M Kasahara K Uryuhara et al. (1999) ArticleTitleImpact of graft size mismatching on graft prognosis in liver transplantation from living donors Transplantation 67 321–327

    Google Scholar 

  30. N Yamanaka E Okamoto E Kawamura et al. (1993) ArticleTitleDynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function Hepatology 18 79–85 Occurrence Handle1:STN:280:ByyA3MrhtlA%3D Occurrence Handle8392029

    CAS  PubMed  Google Scholar 

  31. CM Lo ST Fan CL Liu et al. (1997) ArticleTitleAdult-to-adult living donor liver transplantation using extended right lobe grafts Ann. Surg. 226 261–270 Occurrence Handle10.1097/00000658-199709000-00005 Occurrence Handle1:STN:280:ByiH2sbosFU%3D Occurrence Handle9339932

    Article  CAS  PubMed  Google Scholar 

  32. S Miyagawa Y Hashikura S Miwa et al. (1998) ArticleTitleConcomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation Transplantation 66 661–663 Occurrence Handle1:STN:280:DyaK1cvisVaksQ%3D%3D Occurrence Handle9753351

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments.

We are grateful to the following 11 professors and their department staffs at 11 universities for their permission to use their materials during or after undergraduate dissection practice for medical and dental students: Professor Shigetaka Yoshida, Asahikawa Medical University; Professor Shin Aizawa, Nihon University School of Medicine; Professor Osamu Amano, Meikai University School of Dentistry; Professor Iwao Sato, Nihon Dental University; Professor Masahiko Watanabe, Hokkaido University School of Medicine; Professor Masaharu Horiguchi, Iwate Medical University School of Medicine; Professor Yoshiyuki Tohno, Nara Medical University; Professor Tatsuo Sato, Tokyo Medical and Dental University School of Medicine; Professor Toshihiko Yajima, Health Science University of Hokkaido; Associate Professor Seung-Ho Han, Catholic University Medical College of Korea.

Author information

Authors and Affiliations

  1. First Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Nara, Japan

    Saiho Ko M.D., Tetsuhiro Kanamura M.D. & Yoshiyuki Nakajima M.D.

  2. Department of Anatomy, Sapporo Medical University School of Medicine, South 1 West 17, 060-8556, Sapporo, Japan

    Gen Murakami M.D. & Toshio J. Sato M.D.

Authors
  1. Saiho Ko M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gen Murakami M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuhiro Kanamura M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshio J. Sato M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshiyuki Nakajima M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saiho Ko M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ko, S., Murakami, G., Kanamura, T. et al. Cantlie’s Plane in Major Variations of the Primary Portal Vein Ramification at the Porta Hepatis: Cutting Experiment using Cadaveric Livers. World J. Surg. 28, 13–18 (2004). https://doi.org/10.1007/s00268-003-7294-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-003-7294-z

Keywords

Search

Navigation