Article Outline

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Liver resection surgery has become standard of care for a variety of benign and malignant liver conditions. This, along with the increased number of living-donor liver transplantation procedures being performed, requires ongoing improvement in resection techniques. Historically, these procedures were complicated and high-risk endeavors. However, over the past 3 decades, significant improvements in perioperative outcomes have been realized. This is likely owing to advancing imaging technology, better patient selection, and more informed preoperative planning. In The New Liver Anatomy, Ryu and Cho formalize the application of advanced imaging technology to individualized preoperative planning. In the process, they extend our understanding of liver anatomy with some new and innovative concepts.

The aim of this textbook, based on the foreword and preface, is to “help surgeons who have only a vague understanding of liver segmentation to earnestly study hepatic anatomy” and to “help save many patients with liver cancer and lead to advances in the health, welfare, and happiness of human beings.” It seems likely that this textbook may contribute toward those noble goals. Although perhaps not for the rank-and-file hepatologist, this reference text should be useful to liver surgeons and surgical trainees.

The book is hard cover, contains 36 chapters, and is 186 pages long. It is heavily illustrated with excellent technical diagrams and high-resolution, full-color figures containing 3-dimensional reconstruction of computed tomography (CT) images and intraoperative photographs, giving the book a tremendous visual appeal. Each figure contains an informative legend, and all chapters are fully referenced and indexed. The first chapter summarizes, in a very concise 4 pages, the new anatomic concepts of the anterior fissure, portal segmentation, drainage veins, and liver symmetry. Chapter 2 then reviews previous anatomic classifications of the liver and compares these with the new anatomy. Approximately half of the remaining chapters describe the precise details of various anatomic structures, lobes, and systems within the liver with accompanying 3-dimensional reconstructed CT images. The authors then use a case-based approach to integrate the new anatomy into the major liver resection surgeries using text, diagrams, surgical photos, and 3-dimensional reconstructed CT images.

The early chapters are quite concise and easier to read. The later chapters, although detailed and thorough, become highly technical and more difficult to read casually. Another minor drawback is that, because of the many illustrations, the text referring to a particular figure often appears on the preceding or following page, making it difficult, at times, to refer to the figures while reading. The book's compact size and generally concise chapters make it useful as a surgical reference book that can be read in short sessions. There are multiple authors, but many chapters are written by the editors, Ryu and Cho, and thus there is generally uniformity of style.

One particularly impressive aspect of the book is that the authors show great respect for their forebearers in hepatic anatomy, such as Couinaud. The advantage of this approach is that their work now logically extends previous concepts while also challenging some existing dogma. They do so with the application of new technology (multidetector row CT and voxel-level 3-dimensional reconstruction) to individualize surgical planning based on patients' precise portal, hepatic, and biliary anatomies.

Bottom Line: This book is a carefully conceived and well-portrayed extension of our knowledge of liver anatomy and focuses on using evolving technologies to individualize surgical approaches to liver resection. It will be most useful for liver surgeons and fellows studying hepatic anatomy and planning operative procedures. However, the book may be of broader interest as well to radiologists, researchers studying liver vasculature, and perhaps some anatomically inquisitive hepatologists.