3D visualization-based classification of left intrahepatic vessels and its application in precision hepatectomy

doi:10.12122/j.issn.1673-4254.2025.05.18

Abstract

Abstract:

Objective To establish a three-dimensional (3D) visualization-based classification of the left hepatic portal vein (LHPV) and left hepatic vein (LHV) systems using 3D reconstruction technology to facilitate precise segmental/subsegmental resection of left liver lesions. Methods Thin-slice contrast-enhanced CT datasets from 244 patients were reconstructed using MI-3DV Works software. The spatial anatomy (origins, branching patterns, and spatial relationships) of the LHPV and LHV branches was analyzed to determine their 3D classifications and segmental liver divisions for guiding surgical planning for anatomical left liver resections. Results The 3D models of the third- and fourth-order branches of the LHPV and LHV were successfully reconstructed for all the 244 patients. Two types of the LHPV system were identified, where the LHPV either had independent origins [242 cases (99.1%)] or had right anterior portal branches arising from the LHPV trunk [2 cases (0.9%)]. 3D classifications identified two types of the Segment II of the LHPV (based on branch number), 3 types of the Segment III (by spatial distribution of the branches), compact vs dispersed types of the left lateral lobe (determined by Segment II/III branches proximity), 3 types of the Segment IV (by branch number and origin), and 3 types the fourth hilar vessels (transverse branches of the left portal vein) for their supplied segments. The LHV system had two drainage types into the inferior vena cava, and the umbilical fissure veins were classified into 3 types by drainage patterns and distance to the venous roots. These classifications combined with liver segmentations allowed individualized surgical planning for segment-specific resections. Conclusion The 3D classification of the LHPV and LHV provides valuable clinical guidance for precise anatomical resections of left liver lesions using liver segments or subsegments as anatomical units to enhance surgical accuracy and improve the outcomes of hepatobiliary surgery.

Key words: left portal vein, left hepatic vein, three-dimensional visualization, 3D classification

Jun ZHENG, Zhihua WANG, Xiaojun HU, Xiang HE, Yingfang FAN. 3D visualization-based classification of left intrahepatic vessels and its application in precision hepatectomy[J]. Journal of Southern Medical University, 2025, 45(5): 1047-1055.

Figures/Tables 9

Fig.1 Schematic diagram of 3D directions of blood vessels. A: Schematic diagram of 3D space. B: Schematic diagram of the anatomical position. C: Schematic diagram of the vascular spatial orientation in the anatomical position.

Fig.2 3D classification of the main portal vein. A: The left hepatic portal vein has independent origin, and the yellow vessel is the right branch of the portal vein. B: The right anterior branch of the portal vein and the left branch of the portal vein have a common trunk, and the yellow vessel is the right anterior branch of the portal vein.

Fig.3 3D classification of portal vein segment II. The yellow vessel is the branch of the portal vein segment II. A: 1 branch. B, C: 2-3 branches.

Fig.4 3D classification of segment III of the portal vein. The yellow vessel is the branch of the segment III of the portal vein. A: Branched are distributed in the cephalad and ventral left quadrant. B: Branches are distributed in the foot and ventral left quadrant. C: Branches in both quadrants at the same time.

Fig.5 3D classification of the left lateral lobe of the portal vein. The yellow vessel is the branch of portal vein segment III, the green vessel is the branch of portal vein segment II, and the purple vessel has the shortest distance between them. A: The distance between the origins of the portal vein branch in segments II and III is less than 2 cm. B: The distance is more than 2 cm.

Fig.6 3D classification of portal vein of segment IV. The yellow vessel is from the capsular part of the branch of segment IV, the green vessels is from the sagittal part of the branch of segment IV, and the purple vessel is from the transverse part of the branch of segment IV. A: The branch of the capsular part is clustered and there is no branch in the sagittal part. B: Capsular partial branch + sagittal partial branch. C: Capsular partial branch + sagittal partial branch + transverse partial branch.

Fig.7 3D classification of the fourth hilar vessel. The yellow vessel is the short portal vessel, and the purple vessel is the transverse portal vein. A: The branches supplying the Spiegel lobes. B: The branches supplying caudate lobulocaval part. C: The branch supplying segment II. D: The branches supplying segment IVa.

Fig.8 3D classification of the liver vein. The yellow vessel is the left liver vein, the green vessel is the middle liver vein, and the purple vessel is the right liver vein. A: The left liver vein and the middle liver vein drained into the inferior vena cava. B: The left, middle, and right hepatic veins join the inferior vena cava alone.

Fig.9 3D classification of the umbilical fissure vein. The yellow vessel is the umbilical fissure vein. A: The umbilical fissure vein merges into the root of the left liver vein within 2 cm. B: The umbilical fissure vein merges 2 cm outside the root of the left hepatic vein. C: Umbilical fissure vein merges into the inferior vena cava. D: The umbilical fissure vein merges into the root of the middle liver vein within 2 cm. E: The umbilical fissure vein merges 2 cm from the root of the middle hepatic vein.

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