Why can individual Couinaud segments be surgically resected?

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The ability to remove a single Couinaud segment hinges on each segment functioning as its own unit with independent inflow, outflow, and biliary drainage. In Couinaud’s scheme, a segment receives a dedicated branch of the portal vein and hepatic artery, drains bile through its own bile duct, and empties venous blood into a specific hepatic vein. This anatomical separation creates clear surgical planes, so a surgeon can resect one segment while preserving the others.

Because segments are defined by their separate vascular and biliary pedicles, they do not rely on shared blood supply with neighboring segments in a way that would prevent isolation. The notion that they lack bile ducts or are not surgically accessible isn’t accurate, and the practical reality is that segmental resections are a fundamental principle of liver-sparing surgery.