Question

A surgeon removes a part of the liver to the left of the falciform ligament. Which segments has the surgeon removed?

• A. 1 & 4a
• B. 2 & 3
• C. 1 & 4b
• D. 1 & 3

Hint:

Liver to the left of the falciform ligament is the left lateral section, Couinaud segments II and III.

Answer 1

The Correct Option is B

Step 1: Recall the surface landmark. The falciform ligament marks the boundary on the anterior surface of the liver. The portion of the liver lying to the LEFT of the falciform ligament is the anatomical left lobe.
Step 2: Relate the left lobe to Couinaud segments. The part to the left of the falciform ligament corresponds to the left lateral section, which is made up of Couinaud segments II and III.
Step 3: Name the procedure. Removal of segments II and III is called a left lateral segmentectomy or left lateral sectionectomy (also loosely termed left lobectomy in older nomenclature). It is the standard sublobar resection for lesions lateral to the falciform ligament.
Step 4: Eliminate the distractors. Segment I (caudate lobe) lies posteriorly around the inferior vena cava and is not lateral to the falciform ligament, so any option containing segment 1 is wrong. Segment IV (4a and 4b) lies to the RIGHT of the falciform ligament, so options with 4a or 4b are also wrong.
Conclusion: Segments II and III are removed, so the correct answer is option 2.