History of Hepatic Surgery

The liver is a fragile bleeding mystery

Many years lie between the first historical reports on hepatic anatomy and today's hepatic surgery. One of the first tales is the legend of Prometheus, written by Hesoid (750–700 bc), recounting ancient times. Prometheus stole fire from Zeus, the godfather of ancient Greece, and gave it to mankind. For this infringement, Zeus chained him to a rock and sent an eagle to devour his liver. The liver regenerated and gained its normal size overnight. Each morning the hungry eagle returned, and

Anatomic insights provided the fundamental basis for hepatic surgery

In the nineteenth century, two fundamental concepts enabling major surgery were introduced: anesthesia and asepsis. In 1842, Crawford W. Long used ether as a surgical anesthetic for the first time in the United States. In 1867, Joseph Lister from Glasgow, Ireland, introduced antiseptic techniques against bacterial infections after Louis Pasteur from Paris, France, had discovered the dangers of bacteria.

Before this period, only anecdotal records of hepatic surgery existed. Usually, the surgeons

Liver transplantation: a hard success

The transplantation era was an important period and driving force for the development of hepatobiliary surgery. In 1955, Cristopher S. Welch²² from Albany, New York, published the first report of heterotopic liver transplantation in a dog. J. A. Cannon, Thomas E. Starzl, and Francis D. Moore and colleagues²³ continued with orthotopic liver transplantations (OLTs) in dogs and established the basis for transplantation in humans. In 1963, Starzl and colleagues²⁴ (Fig. 4) made the first attempt to

Hepatic surgery becomes safe and effective

In the sixties, perioperative mortality rates up to 50% were common after right hemihepatectomy. Parallel to the progress in liver transplantation, hepatic surgery, mostly for oncologic diseases, became more sophisticated. In 1983, William P. Longmire and colleagues⁴⁶ from Los Angeles, California, published the results of 138 patients after major resections with a 30-day mortality of 10%. A few years later, in the 1990s, Jacques Belghiti and colleagues⁴⁷ from Paris, France, in a large series of

Summary

Surgical experience and outcomes after major surgery have improved as a result of progress in many fields. Consequently, hepatic surgery has enjoyed a dramatic development during the last 3 decades. Today, liver surgery has lost the threat of the early years. In experienced hands, hepatic surgery has become reliable and effective and has consequently saved the life of many patients.