Morphometric analysis of caudate veins for advanced liver surgery

Background: Accurate knowledge of the surgical anatomy of the caudate lobe is indispensable in the performance of liver surgery. Although previous cast studies have provided much useful overall information about the locations of the caudate veins, little is known about how to establish the exact locations of the caudate and short hepatic veins prior to surgery. Objectives: This study was conducted as a practical morphometric analysis of the caudate veins using preoperative enhanced computed tomography (CT) and intraoperative ultrasound (IOUS). Methods: From July 2003 to October 2005, 116 donor hepatectomies were performed for adult living donor liver transplantation. The numbers and locations of visible caudate veins were examined pre- and intraoperatively using CT and IOUS. Results: In the 116 patients, a total of 152 caudate veins were detected, which were classified as being of either typical (n = 135) or non-typical (n = 17) type. One caudate vein was detectable in 83 patients (72%), two in 30 patients (26%) and three in three patients (3%). A total of 67% of caudate veins detected by IOUS and 70% detected by CT were located on the ventral 60 of the inferior vena cava (IVC). The remaining veins were scattered on both lateral sides. Conclusions: Preoperative CT and IOUS were useful in providing morphometric information of sizable caudate veins. Precise information on these veins is essential for the safe dissection of the caudate lobe from the IVC in advanced liver surgery.