 Good day everybody, I am Sanjay Sanyal professor of department chair. This is a continuation of the previous dissection of the liver But here we are using a different liver specimen because we want to demonstrate some different structures So to bring up the speed, this is the region of the port of Hepatus Which of course has been dissected out and we can see the structures of the extra panic border right entering into the liver This is the fossa for the gallbladder which has been removed So this is the gallbladder fossa which is the part of the right sterile fissure and behind that Pustier part of the right sterile fissure, which is the infiabena cable fissure, which you have mentioned in the previous dissection This is the wrong ligament of the liver Therefore, this is the left sterile fissure the anti apart and further posteriorly This is the ligament of venosum, which is the posterior part of the left sterile fissure Now what we'll do is we will show the transition from the sterile fissure to the portal fissure and how the hepatic segments are created In surgical parlance The right sterile fissure formed by the gallbladder fossa and the infiabena cable is called the main portal fissure On the diaphragmatic surface of the liver This main portal fissure is demarcated by an imaginary line which goes from the region of the Inferior vena cable and goes all the way around and meets with the gallbladder fossa and that line is called the cantile line This cantile line denotes the location of the right sterile fissure on the diaphragmatic surface If we open along the cantile line, we should see the middle hepatic vein Therefore, this is referred to now in surgical language It is referred to not as the right sterile fissure, but it is referred to as the main portal fissure likewise Again, if we come back to the visceral surface This was our left sterile fissure In surgical language, the left sterile fissure becomes known as the left portal fissure or the umbilical fissure Why? Because the round ligament of liver, which is the remnant of the umbilical vein is located here If we were to make an incision along the left sterile fissure, which is now called the left portal fissure or umbilical fissure We should be able to see the left hepatic vein inside And finally, there is no external landmark here But there is a theoretical space behind the cantile line along the anatomical right of the liver Where if we were to make an incision, we should be able to see the right hepatic vein And this forms the basis of the surgical subdivisions of the liver So we shall do exactly that We have split open the liver along three axes We have split open the liver along the portal hepatic and continued it under visceral surface of the liver We have split open the liver along the cantile line And we have split open the liver along the imaginary line posterior to the cantile line And to see what are the structures inside the liver Before I open this and show you and break the suspense Let me just mention a few quick words about glistensia capsule because that is going to be relevant to us I have picked up a facial structure here This is a layer which is under the visceral peritoneum of the liver And this is called the glistensia capsule and you can see This glistensia capsule has got certain unique characteristics It is a layer of fibrosis tissue but it is sensitive to pain And when we are doing liver puncture or any procedure when we pierce the glistensia capsule The patient has pain because it is supplied by somatic nerves My branch is the lower intercostal nerve This glistensia capsule is also the one which is responsible for feeling the stitch-like pain Which we feel in the right hyperconductor and we are jogging Because the blood collects in the liver and it stretches the glistensia capsule and that causes pain This glistensia capsule gives extensions into the liver And it goes along the branches of the intra hepatic border triad And goes into the fissures of the glubule And surgeons use this glistensia capsule extensions into the liver for their dissections And when we do open up the liver and you will find that the liver tissue is filled with reticulate fibres And fibres from this glistensia capsule are the ones which hold the liver hepaticides in place Under the glistensia capsule there is a plexus of lymphatics And in cirrhosis with portal hypertension, this plexus of lymphatics Uses lymph out of the liver surface and which comes to the abdominal cavity And produces a citis of cirrhosis This is called weeping liver Now let's take the first incision which is already shown here That is the cantile line Which as I mentioned extends from the inferior vena cava orifice All the way to the gallbladder fossa And this is the location of the first wild right soluble fissure But now it's called the main portal fissure We have already split the liver at the cantile line And I'm going to separate it We can see the structures here This is the structure which is visible in front of us This is the middle hepatic vein opening into the inferior vena cava Which is deep to the cantile line Just to bring up to speed This is the region of the port hepaticis Which also we have split open And we can see the structures of the extra hepatic portal dried Now becoming intra hepatic portal dried This greedy structure that we see are all the branches of the bile duct Now let's go back again Let's split the liver open along that imaginary line further laterally And that's what we have done And if you look inside You can see the branches of the right hepatic vein And we shall see the right hepatic vein much more clearly Again from the same opening here This is the right hepatic vein And we can see that it's receiving many of the subsidiary veins And the right hepatic vein and then is opening into the inferior vena cava So this right hepatic vein is located in the right portal fissure Middle hepatic vein is located in the main portal fissure And finally Let's bring them together again And let's open in the region of the left seattle fissure Which now has become known as the left portal fissure Or the umbilical fissure And we can see that this is the left hepatic vein My instrument has gone into the left hepatic vein And this is the cut portion of the left hepatic vein Which was opening into the inferior vena cava So therefore to summarize Inside the liver we have the middle hepatic vein In the main portal fissure We have the right hepatic vein In the right portal fissure And the left hepatic vein In the left portal fissure Or the umbilical fissure And all three of them open into the inferior vena cava inside the liver Middle hepatic vein Right hepatic vein Left hepatic vein Thrombotic or non-thrombotic occlusion of the hepatic veins And or the inferior vena cava inside the liver can occur They are referred to as bud sherry syndrome In bud sherry syndrome type 1 The inferior vena cava inside the liver is occluded And bud sherry syndrome type 2 The hepatic veins are occluded Incidentally you may have noticed the friable appearance of the liver tissue While this enables us to surgery by being so far as known as a finger fracture technique But at the same time it is difficult to suture them because of the fravility And also makes them more prone to hemorrhage So this is the basis for doing hepatic segmental resection And this also forms the basis for dividing the liver into 8 segments The portion of the liver between the gallbladder fossa And the fissure for the round ligament This is known as the quadrate lobe Which is part of surgical segment 4 And the space between the fissure for the ligamentum venosum and the inferior vena cava This is called the quadrate lobe And this is called the quadrate process This is allotted surgical segment number 1 Thank you very much for watching ladies and gentlemen This is all for now If you have any questions or comments Please put them in the comment section below Dr. Sanjay Sanyan signing out Have a nice day Don't forget to like and subscribe