CLAUDE COUINAUD is a French surgeon and anatomist who made significant contributions in the field of hepatobiliary surgery. He performed detailed anatomic studies of the liver and was the first to describe its segmental anatomy. He developed the concept of plates and vasculobiliary sheaths of the liver, and performed the first "controlled" hepatectomy by isolating and dividing the Glissonian sheaths going into the liver, prior to parenchymal dissection. He also performed the first biliary bypass to the left hepatic duct and the first "segment III bypass." His book Le Foie: Etudes Anatomique et Chirurgicales stands as the seminal work on hepatobiliary surgery and anatomy of the 20th century.
Claude Couinaud working with his collection of "liver casts" at the school of medicine in Paris, 1988. (Reprinted with permission from Professeur Claude Couinaud.)
Early detailed anatomic drawings of intrahepatic anatomy (clear portion indicates the portal vein, shaded portion indicates the biliary tree, black portions indicate hepatic artery). (Reprinted with permission from: Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. New York, NY: Masson Publishing USA Inc; 1957. Courtesy of Masson Editeur.)
Couinaud's early diagram of the segmental anatomy of the liver. Segments are numbered clockwise with Roman numerals. Segment I is the caudate lobe, not seen underneath. (Reprinted with permission from: La Presse Medicale. 1957;65(50):1158. Figure 4. Courtesy of Masson Editeur.)
Couinaud's diagram of hepatic vein anatomy. The instrument is placed in the avascular space between the right and middle hepatic veins. 1, right superior hepatic vein; 2, middle/left hepatic vein; 3, caudate veins; 4, right middle hepatic vein; 5, right inferior hepatic vein. (Reprinted with permission from: Couinaud C. Surgical Anatomy of the Liver, Revisited. Paris, France: C. Couinaud; 1989. Courtesy of C. Couinaud.)
An early dissection of the plates and vasculobiliary sheaths isolated from the liver. 1, Gallbladder plate; 2, gallbladder; 3, right vasculobiliary sheath; 4, hilar plate; 5, plate of Arantius; 6, umbilical plate; 7, segment II/III vasculobiliary sheaths; 8, ligamentum teres; 9, segment IV vasculobiliary sheath. (Reprinted with permission from Professor Claude Couinaud.)
The first "controlled" left hepatectomy isolating the vasculobiliary elements by dissecting around the left side of the hilar plate prior to parenchymal dissection. (Reprinted with permission from: Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. New York, NY: Masson Publishing USA Inc; 1957. Courtesy of Masson Editeur.)
"Lowering the hilar plate" in preparation to perform a left hepatic duct biliary bypass. (Reprinted with permission from: La Presse Medicale. 1956;64(41):947. Figure 1. Courtesy of Masson Editeur.)
Dissection in the left side of the umbilical fossa in preparation to perform a segment III bypass. (Reprinted with permission from: La Presse Medicale. 1954;62(33):710. Figure 3. Courtesy of Masson Editeur.)
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 9
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination
The Rational Clinical Examination EDUCATION GUIDESHepatomegaly
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.