The caudate lobe of the liver implications of embryology and anatomy for surgery

Abstract

Study of the posterior sector of the liver began in the 1300s with Sylvius' and later Spieghel's [1] description of the lobus exiguus, termed the Spieghel lobe by Glisson in 1654 [2]. (The author's name is Adrien van den Spieghel. In Dutch, Sphieghel means “mirror”; the German spelling, Spiegel, persists in the literature.) Subsequent analysis of anatomy, comparative anatomy, and embryology of the liver led to recognition of the modern hepatic or Couinaud segments, with the Spieghel lobe designated as an independent hepatic segment, termed the dorsal sector, caudate lobe, or Couinaud segment I (C. Couinaud, unpublished data, 1989) [3]. The lobe was described as containing two (left and right) (C. Couinaud, unpublished data, 1989) [4] or three subsegments (the left or Spieghel lobe, the medial paracaval portion, and the right portion or caudate process) [5]. Couinaud and other investigators [6–10] have reported that the right caudate represents separate segment IX. Confusion regarding terminology arises from the proximity of the caudate lobe to the portal confluence, proximal hepatic arteries, and the main hepatic vein–vena cava confluence