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Doody's Review ServiceReviewer: Zoe Stewart, MD, PhD (University of Iowa Hospitals and Clinics)
Description: This book describes a new anatomic classification scheme for liver segmental anatomy. The authors' anatomic model divides the liver into right and left lobes each composed of three segments, in addition to the caudate lobe. The left lobe segments are unchanged from those originally defined by Couinaud. The right lobe segments in the new model are the anterior segment, middle segment, and right lateral segment. After a thorough description of the new segmental anatomy (including a detailed embryologic review to help understand the proposed new anatomy), the authors proceed to describe 17 surgical resections based upon their anatomic model, with two additional surgical technique chapters for special anatomic variations. Each of these operative chapters is accompanied by multiple 3D CT scan reconstructions that were critical to development of the model.
Purpose: After over two decades of experience with liver resections, the authors began to reevaluate the use of Couinaud segmental anatomy with resection based upon the hepatic veins. In particular, the development of high resolution CT scanners and 3D reconstructions led the authors to conclude that a modification to the liver segmental anatomy could lead to improved outcomes after hepatic resection. Most hepatobiliary surgeons who currently have minimal complications with standard hepatic resections will argue that the new classification system is unnecessary. However, it is likely that the use of intraoperative ultrasound to guide resections currently results in the implementation of several of the anatomic principles raised by the authors. Further, there may be situations when preservation of even a limited section of liver may be critical. The book effectively achieves the intended purpose.
Audience: Although the audience is hepatobiliary surgeons, transplant surgeons and fellows also will find it of interest. The authors are recognized leaders in hepatobiliary surgery and lead one of the busiest hepatobiliary programs in Japan.
Features: The authors describe the historical liver anatomic models and then the radiographic and embryologic basis for their new segmental model. They then describe in detail the vascular anatomy in relationship to the biliary tract, including a discussion of several anatomic variants that may be encountered during resection. A series of 18 chapters detail surgical techniques. The book is concisely written and each chapter is accompanied by high quality radiographic images and drawings, the majority of which are in color.
Assessment: This is a valuable contribution to the hepatobiliary field. The detailed text is accompanied by extensive radiographic images and anatomic drawings that convey the complex anatomic relationships with great clarity. Further, the surgical chapters will benefit all hepatobiliary surgeons' operative planning.