With regards to hepatic anatomy, the falciform ligament divides the left medial segment from the left lateral segment?

Hepatic Anatomy: The Falciform Ligament

The falciform ligament divides the left medial segment (segment IV) from the left lateral segment (segments II and III) of the liver. 1

Anatomical Significance of the Falciform Ligament

• The falciform ligament serves as an important anatomical landmark in liver surgery, marking the division between segments III and IV of the liver according to the Couinaud classification system 1
• This ligament is a remnant of the ventral mesentery that extends from the umbilicus to the diaphragm, containing the ligamentum teres (obliterated umbilical vein) 1
• Understanding this anatomical relationship is crucial for surgical planning, especially in liver resections and transplantation 1

Clinical Implications in Liver Surgery

• In liver transplantation procedures, especially split liver transplantation, the anatomical relationship between segments III and IV divided by the falciform ligament is a critical consideration 1
• When performing left hepatectomy, surgeons must recognize that the falciform ligament marks the division between segments III and IV, with segment IV typically being preserved in right-sided resections 1
• This anatomical landmark helps surgeons identify the appropriate transection plane during hepatic resections 1

Surgical Considerations

• The falciform ligament provides a visual and palpable landmark that helps surgeons navigate the complex segmental anatomy of the liver 1
• In procedures such as ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy), understanding the relationship between the falciform ligament and liver segments is essential for proper surgical planning 2
• The falciform ligament's position is particularly important when calculating the future liver remnant (FLR) volume prior to major hepatic resections 2

Radiological Importance

• On imaging studies, the falciform ligament serves as an important landmark for radiologists to identify the boundary between the left medial and left lateral segments 2
• This anatomical division is crucial for accurate reporting of liver lesions and planning interventional procedures 2

Common Pitfalls in Identification

• The falciform ligament may be difficult to identify in patients with cirrhosis due to architectural distortion of the liver 2
• In cases of severe hepatic steatosis or fibrosis, the normal anatomical landmarks including the falciform ligament may be less distinct, requiring careful assessment 2, 3
• Surgeons should be aware that anatomical variations can occur, though the relationship between the falciform ligament and liver segments remains relatively constant 1, 4