Couinaud’s liver segment classification has been the standard for liver surgeryplanning for nearly seven decades. However, its reliance on fixedplanar boundaries does notalways align with individual anatomical variations. This study aims to propose a new methodfor classifying liver functional segments that incorporates patient-specific liver morphology,3D vascular systems, and user-defined landmarks.
Methods. We developed an adaptable clas-sification approach that integrates individual anatomical variations. This approach involves:(1) defining landmarks on 3D models of hepatic and portal veins to compute centerlines,and (2) calculating liver segments by assigning voxel labels based on the proximity to thesecenterlines. We compared our method with conventional plane-based and portal vein-based classifications.
Results. Our method demonstrated greater adaptability by incorporatinghepatic and portal veins, including peripheral branches, and deviating from the classicalCouinaud classification. The findings show that our approach not only overcomes the limi-tations of traditional methods but also provides a more precise and surgery-ready definitionof liver segments, especially in complex cases involving segments 5 and 8.
Conclusion. Our method offers significant improvements in liver segment classification, enhancing visualiza-tion in complex cases and better assessing vascular perfusionterritories. Feedback from liversurgery specialists underscores its potential benefits for surgical planning and outcomes.