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Surgical History |

Claude Couinaud:  A Passion for the Liver

Francis Sutherland, MD, FRCSC; Julie Harris
Arch Surg. 2002;137(11):1305-1310. doi:10.1001/archsurg.137.11.1305.
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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.

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Figures

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Figure 1.

Claude Couinaud working with his collection of "liver casts" at the school of medicine in Paris, 1988. (Reprinted with permission from Professeur Claude Couinaud.)

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Figure 2.

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.)

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Figure 3.

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.)

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Figure 4.

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.)

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Figure 5.

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.)

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Figure 6.

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.)

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Figure 7.

"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.)

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Figure 8.

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.)

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