Variability in intrahepatic portal vein anatomy and its clinical significance in modern hepatobiliary surgery: A literature review

The portal vein (PV), the main vessel that supplies up to 75%–80% of liver blood flow, has long been considered a structure with relatively constant anatomy. Anatomical variants of the PV should be considered important parameters critical to the success of any surgical intervention in the hepatobiliary system. The “standard” anatomy is not present in all patients, with the variant frequency reaching 37%. The most clinically significant variants include main trunk trifurcation, early origin of the right posterior branch, absence of main trunk bifurcation, and origin of right segmental branches from the left PV branch. Anatomical variants not recognized at the preoperative stage increase the risk of massive bleeding, ischemic damage to remaining segments, and iatrogenic bile duct injury. The use of three-dimensional modeling and artificial intelligence allows the minimization of these risks and the transition to personalized surgery. Precise preoperative knowledge of the individual structure of the portal venous system has become an integral component of ensuring surgical safety. Careful consideration of PV anatomy features allows the development of personalized surgical approaches, which are key to successful treatment outcomes in modern high-tech medicine.