tips and techniques of liver surgery

1. Dr Harshal Rajekar MS MRCS DNB
Consultant hepatobiliary and transplant
surgeon, Pune

2.  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.

3. 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.

4.  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.

5. 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.

6. 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

7. 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.

8. 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.

10.  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?source=ig&rlz=&q=liver+tissue+stre
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