Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_585_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
30.08.2026
Размер:
75 Мб
Скачать
2
tic duct
Rig
and biliary tract
Proper hepatic artery
J. Ouyang et al.
Fig. 1.1 Adult intrahepatic bile duct cast specimen. (a) Top view, (b) bottom view
Fig. 1.2 Cast specimen of adult liver ducts. Note: Green for biliary tract and hepatic duct, blue for hepatic vein, red for hepatic artery, and yellow for portal vein
Right posterior segment
Right hepatic duct
Right anterior segment
Right anterior segment
Right hepatic duct
ht posterior segment
a
Left lateral segment
Left hepatic duct
Common hepa
Left medial segment
b
Common hepatic duct
Right hepatic duct
Left lateral segment
Left hepatic duct
Hepatic vein
Portal vein
an acute angle with the common hepatic duct. It is usually formed by the convergence of the right anterior sectoral ducts (RASD) and right posterior sectoral ducts (RPSD). Variations of the hepatic duct and its branches are exceed­ingly common. Accessory hepatic ducts can occasionally be discovered, mostly an accessary right hepatic duct, which often exits the liver at the liver hilum and conuent with the hepatic duct, the cystic duct, or the common bile duct (Couinaud 1989).
Within the porta hepatis, the hepatic duct, the portal vein, and the hepatic artery are closely related. Typically, the left and right hepatic ducts travel in the front, the left and right hepatic arteries in the middle, and the left and right branches of the portal vein in the rear. The proper hepatic artery divides into left and right hepatic arteries before entering the porta hepatis, but the point at which it gives rise to the left
Hepatic duct
and right hepatic arteries is low; the portal vein bisects into the left and right branches, and the junction forms at a slightly higher point; while the union of left and right hepatic ducts was found to be superior to the hepatic arteries. The common hepatic duct is usually located in the right anterior part of the hepatoduodenal ligament; it measures approxi­mately 2–4cm in length with a diameter of 0.4–0.6cm. The inferior aspect of the common hepatic duct then joins the cystic duct coming from the gallbladder to form the common bile duct (Fig.1.3).
1.2.2.2 Gallbladder
The gallbladder is a pear-shaped and thin-walled saccular structure located in a shallow fossa on the visceral surface of the liver, in line with the interlobar ssure that separates the two hepatic lobes. It measures approximately 8–12 cm in
tic duct
Neck
Va
1 Applied Anatomy oftheBiliary Tract
Fig. 1.3 Extrahepatic bile duct
3
Calot triangle
Cystic artery
Fig. 1.4 Composition of the ampulla of Vater
of gallbladder
Cystic gall duct
Sphincter of common bile duct
Major duodenal papilla
ter ampulla sphincter
Vater ampulla
Common hepa
common bile duct
Cystic gall duct
Main pancreatic duct
Sphincter of pancreatic duct
Pancreas
length, 3–5cm in diameter, and 40–60ml in capacity when fully distended. The gallbladder is divided into three sec­tions: the fundus, body, and neck.
The gallbladder fossa projects upward, backward, and to the left, and eventually tapers at the neck. At the junction of the neck of the gallbladder and the cystic duct, a dilatation or pouch may appear, known as ampulla of gallbladder (Hartmann’s pouch). Gallstones commonly impact this sac, producing obstruction and acute cholecystitis.
1.2.2.3 Cystic Duct
The cystic duct extends from the neck of the gallbladder. It is typically 0.3cm in diameter and about 2–3cm long. Spiral mucosal folds, referred to as valves of Heister, are present in the proximal mucosa of the cystic duct, which regulates the bile owing in and out of the gallbladder and prevents the distortion of the gallbladder duct; while the proximal mucosa of the common hepatic duct shows a smooth manner. Gallbladder hydrops can occur when bile duct inammation causes edema of the Heister valves, or when large stones are incarcerated.
The cystic duct merges with the common hepatic duct to form the common bile duct, while the position and entry of the cystic duct into the ductal system are variable. It can run
anteriorly or posteriorly and enter the left side of the com­mon hepatic duct, it can be fused to the right hepatic duct or left hepatic duct, it can also run parallel and enter it more distally.
Calot’s triangle is a triangular space bordered by the cys­tic duct inferiorly, common hepatic duct medially, and the inferior edge of the liver superiorly; it is of particular impor­tance surgically because it contains the cystic artery, the right hepatic artery, and accessory right hepatic duct. This ana­tomical space requires careful dissection during cholecystec­tomy to avoid injury (Fig.1.3).
1.2.2.4 Common Bile Duct
The common bile duct is formed by the junction of the cystic duct and the common hepatic duct. It measures typically about 7–9cm in length and about 0.6–0.8 cm in diameter. The duct can be divided into four portions according to its course and relationships (Fig.1.4).
Supraduodenal Portion
The supraduodenal portion begins at the conuence of the common hepatic and cystic ducts and ends at ampulla of Vater in the second part of the duodenum at the major duode­nal papilla. This portion lies anterior to the portal vein, to the
4
tic artery
Ga
J. Ouyang et al.
right of the hepatic artery proper, and descends along the right edge of the hepatoduodenal ligament. This segment is relatively easy to expose; via which laparoscopic common bile duct exploration, T-tube drainage, choledochoscopy with stone extraction, and Roux-en-Y anastomosis are often performed.
Retroduodenal Portion
The common bile duct passes behind the superior part of the duodenum, with the inferior vena cava on its posterior aspect and portal vein and gastroduodenal artery (GDA) on its left.
Pancreatic Portion
The common bile duct descends through a groove placed on the posterior aspect of the pancreas or within the pancreatic substance. This portion begins at the head of the pancreas and ends at the duodenum wall. This segment is difcult to expose during the operation. In order to reveal it, the poste­rior peritoneum of the lateral duodenum must be dissected, and the duodenum and pancreatic head be removed and turned inward.
Intraduodenal Portion
This course is 1.5–2cm in length, in which the common bile duct passes obliquely through the middle of the medial bor­der of descending duodenum. In 85% cases, the common bile duct and main pancreatic duct pierce the duodenal wall and unite to form a dilated common channel, known as the ampulla of Vater (Ramesh and Sharma 2014). The ampulla of Vater protrudes into the duodenum lumen, and the eleva­tion of the duodenal mucosa forms the major duodenal papilla, opening to the posterior medial wall of the descend­ing duodenum. At the exit, a small complex of smooth mus­cles, known as the sphincter of Oddi, surround the ampulla, terminal parts of the common bile duct, and the main pancre­atic duct. The duodenal papilla is generally 2mm in diame­ter, 3mm in height, and 4mm in width, located in the middle third of the descending duodenum. In another 15–20% cases, they have separate openings for the bile duct and the main pancreatic duct (Misra and Dwivedi 1990). The sphincter of Oddi is a crucial structure regulating the pressure in the bili-
ary system. It controls the openings of the common bile duct and the pancreatic duct and also prevents the regurgitation of duodenal contents into the biliary tract.
The main structures of the hepatoduodenal ligament include the common bile duct, hepatic artery proper, and por­tal vein. The common bile duct lies in the ligament’s right edge, the hepatic artery proper lies to the left, and the portal vein lies posteriorly; hepatic arterial anomalies may occur. The replaced right hepatic artery usually arises from the superior mesenteric artery and the gastroduodenal artery, which has a tremendous guiding value for surgery.
The blood supply of the gallbladder is derived from the cystic artery, which originates approximately 85% of the time from the right hepatic artery and most of which com­mences within the Calot’s triangle. However, there is great variation in the course and origin of the cystic artery. It may also arise from the gastroduodenal artery, right, left, and middle hepatic artery or hepatic artery proper originating from the superior mesenteric artery (Fig.1.5). Venous drain­age is via the cystic veins, which join the right branch of the portal vein. Note, some parts of the small cholecystic venous branches enter the liver directly through the liver bed and ow into the hepatic vein. The blood supply to the hepatic ducts, cystic duct, and the upper portion of the common bile duct is the cystic artery. The blood supply to the medial aspect of the common bile duct is to the right of the hepatic artery proper. The lower part of the common bile duct is sup­plied by the branches of the gastroduodenal artery and pos­terosuperior pancreaticoduodenal artery. Fine branches from the arteries mentioned above, form a reticular epicholedochal venous vascular network on the surface of the common bile duct and anastomose with each other to form plexuses. These arteries conuence into two axial vessels at the 3 o’clock and 9 o’clock positions of the bile duct wall and have an axial course supplying the bile duct. The veins of each bile duct segment converge directly into the portal vein or quadrate lobe of the liver (Figs.1.6, 1.7, and 1.8).
Lymphatic drainage: Lymph drains into the cystic lymph node, which empties into the hepatic lymph node. The lymph nodes of the gallbladder are mainly lymph nodes that meet at the junction of the cystic duct and the common hepatic duct.
Fig. 1.5 The cystic artery originating from the right hepatic artery
Cystic artery
Right hepatic artery
stroduodenal artery
Left hepatic artery
Proper hepatic artery
Common hepa
Right hepatic artery
ry
Ga
3 o'clock artery
Anterior T-shaped arterial network of the common bile duct
1 Applied Anatomy oftheBiliary Tract
Cystic artery
Fig. 1.6 Cast anatomy of cystic artery
Fig. 1.7 Blood supply of
common bile duct
5
The lymph nodes in the upper part of the bile duct merge into the lymph nodes of the gallbladder, the lymph nodes of the liver, and the lymph nodes of omental foramen. The lymph of the gallbladder and the lymph of the liver combine and drain to the lymph nodes next to the common bile duct in the duodenum, which is accompanied by the hepatic artery to the peripheral lymph nodes around the celiac artery. The lymphatics in the lower bile duct are drained to the pancre­atic lymph node and then drain along the axis of the hepatic artery to the lymph nodes around the celiac artery.
Innervation: It mainly refers to the afferent bers of the sympathetic and vagal nerves in the celiac plexus, both of which are distributed in the gallbladder and bile duct; with the branches of the hepatic artery passing through the hepatic plexus. Parasympathetic stimulation produces gallbladder contraction and sphincter of Oddi relaxation, allowing bile outow into the duodenum, while stimulation of the sympa­thetic nerve has the reverse effect (Zhong 1998).
Right hepatic artery
Gallbladder
Cystic artery
Duct of gallbladder
Common bile duct
stroduodenal artery
Common bile duct
9 o'clock artery
Common hepatic duct
Left hepatic artery
Proper hepatic artery
Common hepatic artery
Pancreas
Superior mesenteric arte
Fig. 1.8 Intrahepatic and extrahepatic biliary system and the accompanying arteries
6
J. Ouyang et al.
The composition of the gallbladder wall:
• Mucosa: The mucosa is lined by columnar epithelial cells with absorption function and contains specialized tubu­loalveolar mucous glands that secrete sticky mucus. The gallbladder mucosal is variably folded, which increases the total surface area for inspissating bile.
• Muscularis externa: Consists of the thick inner longitudi­nal, the outer circular, and the middle elastic brous tissues.
• Adventitia: Adventitia is made up of a thick layer of con­nective tissue, and a layer of mesothelium covers adventi­tia on the free surface.
The composition of the extrahepatic bile duct wall:
• Mucosa: The mucosa contains such mucous cells as gob­let cells that secrete mucus.
• Smooth muscle and elastic ber layer: Stimulation causes spasmodic contraction of the muscle bers.
• Serosa: The serosa is made up of a layer of connective tissue rich in nerves and blood vessels.
1.2.3 Anatomy oftheBiliary Cast
Tremendous advances in medical technology and update of medical equipment have driven the eld of modern surgery forward into the current minimally invasive approaches and precision procedures. Moreover, the development of surgical navigation systems, virtual surgery, and robotic surgery have necessitated examining the distribution of small blood ves­sels in 3D spaces. Accurate surgical treatment has put for­ward higher requirements for understanding complex intrahepatic anatomical structures, and further strengthening the understanding of it will undoubtedly greatly enhance the therapeutic effect on biliary diseases.
The development of biliary surgery has beneted from
studies on vascular structures of the liver. The internal vascu­lar and ductal anatomy of the liver is complex (Hjortsj 1951). In recent years, the trend in biliary tract surgery is toward minimal invasive, individualized, and delicate procedures, while precision surgery should be based on advanced ana­tomical knowledge. Concerning the researches on the anat­omy of the liver, the gross anatomy of cadavers, and corrosion cast methods are primarily used (Spitzer et al. 1996). Meanwhile, the widespread application of digital technology and an increasing number of researches into intrahepatic anatomical structure using these techniques has further deep­ened people’s understanding of the anatomy of the liver (Figs.1.9 and 1.10) (Wigmore etal. 2001).
Vascular corrosion casting is a widely used dissection technique in medical education and clinical research, which can visualize the complex three-dimensional structure of the human hepatic vasculature. It resembles casting technology in the industry. However, it is based on the natural vascular or cavity structure in viva (such as blood vessels, lymphatic vessels, ventricles, hepatic ducts, and pancreatic ducts). The vascular structures are perfused with a xative (such as plas­tic or denture powder). When the injected substance becomes hard, the specimen is submersed in a strong acid or alkali solution. The tissue is subsequently corroded away, while the hardened cast remains because of its strong acid and alkali resistant properties. The whole process is known as vascular corrosion casting. The casting technique dates back to fteenth to sixteenth century Italy. The famous painter, Da Vinci, produced a wax cast of cerebral ventri­cles. Since then, a variety of mold specimens have been pro­duced using materials such as low-melting point alloys and celluloid. By the 1970s, the casting technique had entered a new stage of development thanks to the advances in the modern chemical industry. Many premium-quality plastic products, such as perchloroethylene and styrene, have been utilized as lling materials in the casting process. While perfusing, a low- concentration xative is recommended since the diameter of the bile duct system is relatively small. At the rst perfusion, it should be performed after bile is squeezed out through the common bile duct. The bile duct system may not be adequately perfused at one time, and in that case, reperfusion is needed on the post-perfusion day 2 or 3. Anticorrosion and xation are very important, and the natural shape of the liver should be maintained to avoid deformation under pressure.
Bile duct and adjacent structures are xed.
1.3 Isolated Biliary Tract andVascular
Perfusion
Studies on intrahepatic vascular structure have aided advances in biliary tract surgery; further, it has been pushed into a new stage by dramatic improvements in modern imag­ing modalities (such as spiral computed tomography (CT), and MRI). Nonetheless, biliary tract surgery still faces sig­nicant challenges due to the complexity and variability of intrahepatic vascular structure; and lack of sophisticated research on and three-dimensional imaging of it. Currently, with the development of the clinical anatomy of biliary tract and biliary tract surgery, modern imaging techniques as well as their mutual integration, studies have achieved the visual­ization of image dataset and intrahepatic vessels and simula­tion of biliary tract operations.
Common hepatic Duct
Duct of gallbladder
Right hepatic duct
1 Applied Anatomy oftheBiliary Tract
7
Fig. 1.9 Perfusion of the gallbladder, bile duct, portal vein, and artery Note: Green for the bile duct and hepatic duct, red for the hepatic artery, white for the portal vein
Gallbladder
Duct of gallbladder
a
Right hepatic duct
Left hepatic duct
b
Common bile duct
1.3.1 Intrahepatic Vascular Perfusion
While studying the biliary perfusion, the other three sets of intrahepatic vasculatures (the hepatic artery, portal vein, inferior vena cava/hepatic vein) should be properly perfused as well (Fang etal. 2007). Satisfactory images of the pipe­lines should be generated during the CT scan. Based on CT values, the four vasculatures may need to be extracted, removed, and 3D reconstructed separately. Such objectives can be achieved by the following two protocols.
Technique
Duct of gallbladder
Gallbladder
c
powder. Though perfused satisfactorily, the pipelines are incapable of being identied, extracted, and 3D recon­structed because they possess the same CT value on CT images and the thin hepatic artery and bile duct system. The entirety of the portal and hepatic veins within the hepatic lobes and segments can be displayed during 3D reconstruc­tion when the perfusion of the portal vein and hepatic vein is satisfactory, and thin-slice CT images are clear.
centrations of vermilion powder. Because of the concentra-
Left hepatic duct
Common hepatic duct
Firstly, the four pipelines are injected with 10% vermilion
Secondly, four pipelines are injected with different con-
8
Hepatic artery
Biliary system
J. Ouyang et al.
Fig. 1.10 Perfusion of the gallbladder, biliary tract, and hepatic artery. (a) Anterior view, (b) posterior view. Note: Green for the gallbladder, biliary tract, and hepatic duct; red for the hepatic artery
Hepatic artery
Biliary system
a
Gallbladder
b
Hepatic artery
Gallbladder
tion differences, CT showed different CT values during scanning. According to the differences, the four pipelines are 3D reconstructed. Note, at the rst perfusion bile should be squeezed out through the common bile duct, since the hepatic artery and bile duct system are relatively small in diameter.
The bile duct system may not be adequately perfused at one time, and in that case, reperfusion is needed on the post­perfusion day 2 or 3. Anticorrosion and xation are vital. The natural shape of the liver should be maintained to avoid deformation under pressure, lest distortion of the mold dur­ing casting occurs. The portal vein and inferior vena cava are relatively thick and even more so in fresh specimens. In the casting process of large vessels, it is better for the vessels to be thick and sparse, rather than to be thin and dense. To reduce the blood vessel elasticity, traditional anticorrosive methods should be utilized for vascular xation. During the anticorrosive process, attention must be paid upon leakage of perfusate from vasculature surrounding the liver. In the event of such leakage, blood vessels can be ligated using hemo­static forceps or wire sutures. Since the portal vein and infe­rior vena cava are relatively thick, the lling agent must be strong and non-brittle to support the weight of the liver. The effect of using the rapid repair powder and liquid for acrylic denture as lling agents is rather satisfactory. The model of the human body, diaphragm, and abdominal cavity is con-
structed out of berglass. Then, the liver is placed in the abdominal cavity, in an anatomical position similar to that of the human liver and examined with a thin layer CT scan and MRI, which can display clear intrahepatic vascular struc­tures and achieve strong stereoscopic effects.

1.3.2 Data Acquisition

1.3.2.1 Collection andDissection ofBiliary Specimens
Cadaver specimens were obtained from the Institute of Clinical Anatomy of Southern Medical University. The liga­mentum teres hepatis, falciform ligaments, left and right tri­angular ligaments were resected, and the liver was mobilized. The hepatic artery, portal vein, and common bile duct were severed horizontally at the duodenal bulb, and the inferior vena cava was severed above the level of the right renal vein. The vena caval foramen of the diaphragm was opened, the superior and inferior vena cava severed, and the liver pro­cured intact. Then, the liver was perfused through the portal vein with saline or tap water until the color of the liver changed or partially whitened. The broken end of the infra­hepatic vena cava was sutured continuously. Small diameter cannulae were inserted in the hepatic artery and common
1 Applied Anatomy oftheBiliary Tract
9
bile duct and ligated with sutures. Large diameter cannulae were inserted in the portal vein and suprahepatic vena cava and ligated also. To avoid perfusate leakage while perfusing, small blood vessels in the hepatic hilar area were ligated with silk thread.
1.3.2.2 Bile Duct Perfusion
Two perfusates (yellow) of different concentrations of ver­million powder were prepared:
• 10% vermilion powder, perchloroethylene, and yellow oil paint
• 5% vermilion powder, perchloroethylene, and yellow oil paint
1.3.2.3 Hepatic Artery Perfusion
Two perfusates of different concentrations were prepared:
• Red perfusate: 10% vermilion powder, perchloroethy­lene, ethyl acetate, and red oil paint.
• Dark red perfusate: 20% vermilion powder, perchloro­ethylene, ethyl acetate, and red oil paint.
1.3.2.4 Specimen Perfusion Fixation
The specimen, which was perfused through the hepatic artery and bile duct were submerged in gauze saturated with water, and a 10% formalin solution was infused through the portal vein. The portal vein and inferior vena cava were clamped once formalin started to ow out through inferior vena cava.
1.3.2.5 Perfusion andFixation ofthePortal Vein,
Inferior Vena Cava, andHepatic Vein
1.4 Digitalized Biliary Tract andBlood Vessels

1.4.1 Liver Dissection after Biliary Tract Perfusion

The isolated liver model perfused by four perfusates with respective colors, was embedded with blue gel. Eight brown­red markers were placed surrounding the liver as image reg­istration points. The liver was stored in a freezer for 3 weeks at a temperature of 25°C and subsequently transferred to the laboratory at 27 °C. The liver was then serially sec­tioned at 0.2mm intervals with the JX1500A vertical milling machine. The serial cross-sections were photographed using a high-resolution digital camera to produce anatomical images, which were uploaded to a computer.
1.4.2 Acquisition andAnalysis ofSectioned Images
Cross-sectional pipelines were well displayed, and all pipe­lines were clear. The inferior vena cava and hepatic vein sys­tem were black, and the portal vein system was orange. The hepatic artery, which runs alongside the portal vein was red. The hepatic duct and the gallbladder were dark green. The peripheral hepatic vein and portal vein were clear.
Intervals of the anatomical images were 0.2mm, and 910 pairs of cross-sectional images were acquired. The data le of each section occupies 17.5MB, and the le size of the liver dataset was 15.3GB in total (Fig.1.11).
Perfusion andFixation ofthePortal Vein
Two perfusates of different concentrations were prepared:
• Brown perfusate: 60g of rapid repair powder for acrylic denture, 60ml of rapid repair liquid for acrylic denture, 12g of 10% vermilion powder, 15ml of dibutyl phthalate, and brown oil paint.
• Yellow perfusate: Yellow oil paint and the other compo­nents were the same as above.
Perfusion andFixation oftheInferior Vena Cava/ Hepatic Vein
Two perfusates of different concentrations were prepared:
• Blue perfusate: 60 g of rapid repair powder for acrylic denture, 60ml of rapid repair liquid for acrylic denture, 12g of 10% vermilion powder, 15ml of dibutyl phthalate, and brown oil paint.
• Light red perfusate: White oil paint, 12g of 8% vermilion powder, and the other components were the same as the above.
1.4.3 3D Reconstruction ofImages
Three-dimensional reconstruction of the cross-sectional images obtained through milling was achieved after registra­tion and segmentation. These images were converted into BMP format to facilitate the subsequent processing (Fig.1.12).
1.4.3.1 Image Registration After Bile Duct Perfusion
Image registration was conducted by external point force combined with moment-to-force. The landmarks pre­embedded surrounding the liver were set as registration points. The image registration was performed based on the relatively xed positions between the liver and those land­marks. The specic methods are:
• In the source image, the registration points were displayed
on a blue background presenting as dark red point set scattered around the image. These point sets were identi­ed according to the color and their position features.
10
Right hepatic artery
Common hepatic duct Common bile duct
Hepatic artery
Portal vein
J. Ouyang et al.
Fig. 1.11 Cross-sectional images of the hepatic hilum
a
Right hepatic vein
Right portal vein
Right hepatic duct
Portal veinHepatic artery Gallbladder
Hepatic artery
Right portal veinLeft hepatic vein
b
Common hepatic duct
c
Right hepatic duct
Portal vein
Right hepatic artery
Hepatic vein
GallbladderCommon bile duct
Hepatic vein
Right portal vein
GallbladderCommon bile duct
y
Hepa
1 Applied Anatomy oftheBiliary Tract
Fig. 1.12 The display window and 3D reconstructed liver
11
Fig. 1.13 Image registration of the sectioned images after intrahepatic pipe perfusion (the white arrow points to the registration point)
tic artery
• After a comparison of the source and target images, trans­lation and scaling of each image should be performed so that each point of one image can be mapped to a corre­sponding point of another image.
• The area containing the liver was sheared from the source image (Fig.1.13).
1.4.3.2 Image Segmentation After Bile Duct
Perfusion
Image segmentation is the process of partitioning an image into multiple meaningful segments according to certain prin­ciples. Segmentation of milled images is the extraction of tissues from the liver. The image data of liver parenchyma, hepatic veins and inferior vena cava, portal veins, hepatic artery and gallbladder, and hepatic artery were respectively segmented, and their contour line was extracted.
Hepatic arter
1.4.3.3 3D Reconstruction oftheBiliary Tract
• Three-dimensional surface rendering reconstructions were generated from image sequences using the Visualization Tool Kit (VTK). Specic methods were: contour lines were extracted into several of these tissue types on every image; the region between contour lines of adjacent images were lled with at triangles, which formed a banded ring; the 3D surface of the object was generated from a set of contour lines.
• The reconstructed liver model was displayed using the surface description method. The model contains ve parts, including the liver, the hepatic vein and inferior vena cava, the portal vein, the hepatic ducts and gallblad­der, and the hepatic artery. Also, a Windows PC-based 3D visualization demonstration system and Windows operation system of liver were developed. By clicking on