Reconfirmation of the right medial division of the portal venous system of liver

With the development of hepatic surgery and radiology, an increasing amount of researchers have reported discrepancies between the real distribution of the hepatic portal vein branches and Couinaud's segmentation, especially for further division of the right medial division. The present study investigated 25 cadaveric liver dissections and 30 three-dimensional reconstruction images of intrahepatic vessels. The ramifications, course, distribution and quantity of the portal branches were analyzed. An oblique fissure that had few vessels was found among third-order branches of the hepatic portal vein of the right medial division. The right medial division could be redivided into the ventral subsegment and dorsal subsegment by this oblique fissure. A hepatic vein coursed in the oblique fissure between the ventral subsegment and dorsal subsegment. The hepatic vein could serve as an anatomical landmark of the inter-subsegmental plane. This new method of identifying further division of the right medial division is a novel concept providing further information on conventional segmental anatomy.