Anatomical variations of the liver and its suspensory system: a cadaver‐based study
Authors: Arnould Beryl , Décarie Pascale , Venne Gabriel 
Published: May 2022

Introduction & ObjectiveNon‐traumatic musculoskeletal (MSK) pain has become a socio‐economic burden, being the leading cause of absenteeism and prolonged disability. Despite all medical advances, the origin of this pain is still unclear. Studies have reported theories on the role of fascia, nociceptive stimulation, and visceral (im)mobility, and provided evidence for the success of visceral manipulation therapy. The influence of viscera on the MSK system is neglected in scientific research, even though the human body functions best when its components, including the viscera, are free to move in full range. Thus, to understand the role of visceral mobility on the MSK system, this study aimed to investigate the anatomical variation of the liver’s suspensory system via physical measurements and 3D surface scanning. It is hypothesized that anatomical variations will exist.Materials & MethodsWith IRB clearance, fourteen of twenty‐two formaldehyde‐fixed donors were selected for this study; the other eight donors excluded due to pathology affecting the region of interest. Using gross dissection, livers and diaphragms were isolated. Using a string and a digital micrometer, the length and thickness of the triangular ligaments, the falciform ligament, and the circumference of the bare area was measured for each selected donor. Each isolated liver was weighed. Using a structured light scanner, each liver and suspensory system (bare area and aforementioned ligaments) were digitalized for future analysis.ResultsThe mean lengths (mm) of the left triangular ligament edges were 55.70 ± 27.1, 88.38 ± 31.69, and 63.62 ± 28.76. The mean lengths (mm) of the right triangular ligament edges were 35.32 ± 21.15, 46.98 ± 51.83, and 33.28 ± 21.83. The mean lengths (mm) of the falciform edges were 102.75 ± 30.40, 172.32 ± 35.70, and 105.51 ± 49.25. The mean thicknesses (mm) of the left and right triangular ligaments, and the falciform, were 0.32 ± 0.16, 0.32 ± 0.20, and 0.34 ± 0.31, respectively. The bare area circumference was 443.12 ± 98.38mm, and the mean liver weight was 1439.09 ± 752.39g.ConclusionThis dissection‐based study provides evidence of a broad range of anatomical variations that exists between livers and suspensory system, emphasizing the uniqueness of the human body’s anatomy.Significance/ImplicationThis was the first study to examine the morphological variation of the liver’s ligaments and bare area via meticulous physical measurements. The results suggest that the liver’s suspensory system has carefully adapted to each body’s needs and demands. Understanding and visualizing this could help train clinicians who provide visceral manipulation therapy to the liver for MSK pain. A patient’s specific liver morphology may differ greatly from standard anatomy textbook descriptions, so recognizing the anatomical variation of the liver’s suspensory system and the potential impact it has on the MSK system could lead to alternative and improved treatments. Further research could include statistical modeling from the 3D digitalized models. To understand the actual role of the liver’s suspensory system in influencing the MSK system, the biomechanical and proprioceptive properties of the ligaments should be researched.