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SurgSpace / Specialties / Hepatobiliary Surgery

Hepatobiliary Surgery

Liver, biliary tree and pancreas: the most anatomy-dense corner of general surgery, where the operation is planned segment by segment on imaging before the incision, and where variant ducts and vessels are the rule rather than the exception.

4 operations in depth5 interactive cases

Backdrop: Contrast CT of the upper abdomen with multiple low-density liver metastases replacing much of the right lobe · James Heilman, MD · CC BY-SA 3.0

Inside the OR

OR & Periop

Shared operative foundations, the room, the instruments, the anaesthetic.

Shared operative foundations taught once, the room they happen in, the instruments on the tray, and the anaesthetic that makes it possible.

  • The liver's segmental anatomy

    Couinaud's segments turn the liver from an organ into an operable map: eight territories, each with its own portal inflow, arterial supply and biliary drainage. Resection planning, tumour reporting and the operation itself all speak this language.

    1. 01The principle. The liver divides by its vessels, not its surface: the portal vein's branching defines segments, and the three hepatic veins run in the planes between them.
    2. 02The map. Segment I (caudate) at the back; II to IV form the left liver; V to VIII the right: radiologists report lesions by these addresses and surgeons resect by them.
    3. 03Why it enables surgery. A segment can be removed along its vascular boundaries with its inflow controlled first: anatomic resection bleeds less and leaves neighbours fully supplied.
    4. 04The remnant arithmetic. Plans are constrained by what remains: enough volume, with inflow, outflow and bile drainage intact. Portal vein embolisation grows the remnant before surgery when arithmetic falls short.
    5. 05Reading the CT. Find the hepatic veins and the portal bifurcation and the segments assemble themselves: the skill is learnable in an afternoon and used for a career.
    Used byLiver resection (segmentectomy)Pancreaticoduodenectomy (Whipple)

  • The obstructed, infected system

    One rule underlies the specialty's emergencies and echoes across all of surgery: an obstructed system that becomes infected must be drained. Cholangitis is the reference example; the blocked kidney and the abscess follow the same law.

    1. 01The physics. Obstruction raises pressure; stagnation breeds infection; pressure then pushes organisms and endotoxin into the bloodstream. The combination, not either alone, is what kills.
    2. 02Why antibiotics are not enough. Drugs cannot sterilise a pressurised, undrained space: they buy time and cover the bloodstream while the drain does the treating.
    3. 03Routes. Decompress by the least invasive adequate route: endoscopically (ERCP), percutaneously (transhepatic drain, nephrostomy for the kidney's version), or surgically when both fail.
    4. 04Source and cause. Drainage treats the episode; the obstructing cause, stone, stricture, tumour, still needs its own definitive plan, or the story repeats.
    Used byERCP with sphincterotomyLaparoscopic cholecystectomyPercutaneous nephrostomy

On the tray

Anaesthesia

The airway, the depth, the haemodynamics and the analgesia: the head of the bed has its own rooms.

Enter anaesthesia

Watch and learn

When an operation is best understood in motion

Watch for

Laparoscopic cholecystectomy

  • Access & insufflation
  • Exposure
  • Critical View of Safety
  • Clip & divide
  • Gallbladder off the liver bed
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Watch for

Pancreaticoduodenectomy (Whipple)

  • Assessing resectability
  • Kocherisation and dissection
  • The resection
  • Reconstruction
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Watch for

ERCP with sphincterotomy

  • Reaching the papilla
  • Selective biliary cannulation
  • Sphincterotomy and clearance
  • Ensuring drainage
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Embedded videos are curated and attributed. The search doors are labeled searches for reviewers to source candidates from, not endorsements; nothing plays here until it has been reviewed.

Hub shaped by the Surgical Specialties Lead with the Hepatobiliary surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.