Liver Surgery & tissue handling

Dr Harshal Rajekar MS MRCS DNBConsultant hepatobiliary and

transplant surgeon, Pune

The myth Prometheus enraged the Gods after

climbing the Mount Olympus and stealing the torch in order to give fire to the humans.

He was punished by Zeus and chained to a rock in the Kaukasus Mountains. Every couple of days, an eagle came and ate part of his liver.

As the liver regenerated every time, the eagle returned again and again to eat the liver and thereby torture poor Prometheus.

Glisson performed extensive investigations of the vascular anatomy in 1654.

It was more than two centuries before his work was rediscovered and further clarified by Rex (1888) in Germany and Cantlie (1897) in England.

These contributions led to the division of the liver into the present left and right lobe as we know them.

The History Langenbuch was the first to perform a

successful elective liver resection in 1887 and Wendel did the first hemihepatectomy in 1911.

The principles of liver haemostasis and regeneration were determined in the period 1880-1900.

The knowledge of the principle of inflow and outflow of the liver and vascular control was one of the major advancements.

Before that, wedge resections and mattress sutures were mostly used.

This insight of inflow and outflow reduction was marked by the publication of James Hogart Pringle of Glasgow, Scotland.

He described the idea of digital control of the hilar ligament to reduce liver haemorrhage.

In the beginning, however, blood loss and mortality were considerable.

A multicentre analysis in 1977 of more than 600 hepatic resections for various indications showed an operative mortality of 13%, which rose to 20% for major resections

Liver Surgery The first hepatectomy for cancer was

reported by Ichio Honjo (Kyoto University) in 1949, and

Jean-Louis Lortat-Jacob in 1952, the patient being a 58-year-old woman diagnosed with colorectal cancer which had metastasized to the liver.

Peculiar? Longmire, called it a "hostile" organ

because it welcomes malignant cells and sepsis so warmly, bleeds so copiously, and is often the 1st organ to be injured in blunt abdominal trauma.

Yet, the liver is able to to regenerate after massive loss of substance, and is able, in many ways, to forgive insult.

http://en.wikipedia.org/wiki/Hepatectomy http://www.soering.com/applications/liver_surgery/ http://www.intechopen.com/books/hepatic-surgery http://pie.med.utoronto.ca/tvasurg/ http://www.surgeryencyclopedia.com/Fi-La/Hepatectomy.html http://www.rams.umd.edu/pdf/IROS2003_1.pdf https://www.google.com/search?

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