Functional liver anatomy: Surgical impact

The liver is a vital gland with a wide range of functions and complex anatomy. Liver anatomy can be described using different aspects: morphological anatomy and functional anatomy and now, the real anatomy, when ultrasound allows a precise intraoperative display in individual cases. The traditional morphological anatomy is based on the external appearance of the liver and does not show the internal features of vessels and biliary ducts branching which are of obvious importance in hepatic surgery. Functionally the liver is divided into eight functionally independent segments, each segment has its own vascular inflow, outflow and biliary drainage. This description, initiated by J. Cantlie in 1898, was followed by works of J. Healey and P. Schroy, N. Goldsmith and R. Woodburne, C. Couinaud, and H. Bismuth. In 1998. Federative Committee on Anatomical Terminology (FCAT) suggested using the liver Couinaud's classification. In 2000, International Hepato-Pancreato-Biliary Association (IHPBA) in Brisbane presented their recommendations of terminology of liver anatomy and liver resections. A single, worldwide-accepted classification of the liver still does not exist, however progress in the study of functional anatomy of the liver is a powerful impulse for development of modern liver surgery.