Cantlie’s Line: Surgical Significance and Anatomy

Definition

Cantlie’s line is an imaginary line used to divide the liver into functional right and left lobes, based on segmental vascular and biliary anatomy rather than surface morphology.

Anatomical Course

• Anteriorly: Starts at the middle of the gallbladder fossa

• Posteriorly: Ends at the inferior vena cava (IVC), at the insertion of the left hepatic vein

• Plane: Corresponds with the middle hepatic vein, lying in the main portal fissure (also called the principal plane or Rex-Cantlie line)

Surgical Relevance

1. Functional Division

• Divides liver into right and left functional lobes, based on vascular supply instead of surface anatomy and morphology.

• Each lobe has independent portal inflow, arterial supply, biliary drainage, and venous outflow

2. Segmental Anatomy

• Cantlie’s line lies between Couinaud segments II, III, IVa and IVb (left) and V, VI, VII and VIII (right)

• Important for segmental or lobar liver resections

3. Surgical Landmarks

• Approximates the course of the middle hepatic vein

• Used to guide parenchymal transection planes during liver surgery

• Can be identified with intraoperative ultrasound

• Can also be identified on CT Scan pre-operatively for pre-operative planning.

4. Liver Transplantation

• Crucial in living donor liver transplantation (e.g., right lobe grafts)

• Helps balance graft-to-recipient weight ratio and preserve vascular integrity

Clinical Applications

Summary

Cantlie’s line is a cornerstone of modern liver surgery, enabling safe anatomical resections, trauma management, and effective planning in transplantation. Its alignment with internal vascular structures—not surface anatomy—makes it invaluable for both open and laparoscopic hepatic procedures.

Cantlie’s Line: Sources and Visual References

Key Educational Sources

1. Wikipedia – Cantlie Line

   Provides an overview of Cantlie’s Line, including anatomy and clinical relevance.

   🔗 https://en.wikipedia.org/wiki/Cantlie_line

2. Radiopaedia – Cantlie Line

   Radiologic and surgical anatomy of Cantlie’s Line.

   🔗 https://radiopaedia.org/articles/cantlie-line-1

3. The Radiology Assistant – Liver Segmental Anatomy

   Excellent segmental liver anatomy resource with diagrams.

   🔗 https://radiologyassistant.nl/abdomen/liver/segmental-anatomy

4. AccessSurgery – Liver and Biliary Tract

   Detailed surgical context of liver anatomy and resections.

   🔗 https://accesssurgery.mhmedical.com/content.aspx?bookid=2057&sectionid=156215914

5. ScienceDirect – Liver Segmentation: Practical Tips

   Insights into liver segmentation with practical applications.

   🔗 https://www.sciencedirect.com/science/article/pii/S2211568413003744

🖼️ Visual References

1. Radiopaedia – Cantlie’s Line Diagram

   Schematic line from gallbladder fossa to IVC.

   🔗 View Image

2. The Radiology Assistant – Segmental Anatomy Diagram

   Liver segments with Cantlie’s Line clearly marked.

   🔗 View Image

3. ResearchGate – Cantlie’s Line in Imaging

   Imaging-based visual showing Cantlie’s Line.

   🔗 View Image

4. Anatomy.app – Liver Segments and Cantlie’s Line

   High-resolution anatomical illustration of liver segments.

   🔗 View Image