From the Research
The Cantlie line is a crucial anatomical landmark in liver surgery, but its reliability as a landmark for major hepatectomy can be compromised by variations in the primary portal vein ramification, as demonstrated by a study published in the World Journal of Surgery in 2004 1.
Significance of the Cantlie Line
The Cantlie line is an imaginary line that divides the liver into functional right and left lobes, running from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. It represents the watershed between territories supplied by the right and left branches of the portal vein and hepatic artery.
Clinical Implications
Understanding the Cantlie line is essential for surgeons to identify appropriate transection planes during hepatectomies, ensuring adequate blood supply and biliary drainage to the remaining liver tissue. This landmark is critical in major liver resections, living donor liver transplantation, and complex hepatectomies for tumors near the center of the liver.
Limitations and Variations
However, a study published in 2004 found that major variations in the primary portal vein ramification, such as trifurcation or an anterior sectorial trunk originating from the left portal vein, can alter the segmental configurations of the liver, making the Cantlie line and the middle hepatic vein less reliable as landmarks 1.
Diagnostic Approaches
Intraoperative ultrasound can be used to precisely locate the Cantlie line by identifying the middle hepatic vein, which typically runs along this plane. Additionally, knowledge of the sonographic features of hepatic vascular anatomy is indispensable, particularly in critically ill patients, as demonstrated by a study published in the Journal of Ultrasound in 2007 2.
Key Considerations
Surgeons must be aware of the potential variations in liver anatomy and use a combination of anatomical landmarks and diagnostic tools to ensure accurate identification of the Cantlie line and preservation of vascular inflow and outflow to the remnant liver. The most recent and highest-quality study on this topic, published in 2004, highlights the importance of considering individual anatomical variations when using the Cantlie line as a landmark in liver surgery 1.