Anatomy of the right portal vein and right hepatic vein for anatomical minimally invasive liver resection

Abstract

Background

Anatomical minimally invasive liver resection requires an understanding of hepatic vascular anatomy to minimize complications and optimize outcomes. This study characterized variations in right portal vein (RPV) and right hepatic vein (RHV) anatomy using three-dimensional (3D) computed tomography (CT) reconstruction and established a practical classification system to guide surgical planning.

Methods

Contrast-enhanced CT images from 569 patients without known liver disease were analyzed at a single Chinese tertiary center. 3D reconstructions were performed using the Hisense CAS system. RPV and RHV vascular branching patterns were systematically evaluated and classified according to their origins, bifurcation points, and relationships to Couinaud segments and Glissonean pedicles.

Results

We identified four distinct RPV branching patterns: Type A (68.5%) showed classical bifurcation into right anterior and posterior portal veins from a common RPV trunk; Type B (19.9%) showed direct branching from the main portal vein; Type C (3.9%) showed anomalous branching with the right anterior portal vein (RAPV) originating from the left portal vein; and Type D (7.7%) showed trifurcation. For the right hepatic vein (RHV) drainage, we identified three types, with Type A (a single dominant trunk, 68%) being the most common. Accessory RHVs were present in 49.7% of the patients, making them the most frequently observed anatomical variation.

Conclusion

Our study demonstrates substantial anatomical variation in right-sided hepatic vasculature, with accessory RHVs present in nearly half of our patients. 3D CT reconstruction provides accurate preoperative vascular mapping that is essential for safe anatomical minimally invasive liver resection. Our classification system enables individualized surgical planning and facilitates the craniocaudal Glissonean approach for segment-oriented liver resection.