Frontiers of Liver Surgery

In the past, liver surgery has had key opportunities to undergo a dramatic evolution. These were supported by several innovative discoveries and inventions. The establishment of detailed knowledge of liver anatomy played a critical role in the development of liver surgery. As epoch-making events in anatomy, the discovery of the vasculo-biliary sheath (Francis Glisson, 1654), the definition of the right and left liver by Rex-Cantlie's line (Hugo Rex and James Cantlie, 1888 and 1889), the discovery of the hepatic venous system (Ton That Tung, 1939), as well as the identification of liver segments according to the portal system (Claude Couinaud, 1954) can be named. Regarding the aspect of surgical technique, cross-clamping of the hepatic pedicle (James Hogarth Pringle, 1908), preliminary vascular control (Jean-Louis Lortat-Jacob, 1952), and the finger fracture method (Tien-Yu Lin, 1960) formed the basis for the present procedures. This precise knowledge of anatomy and the corresponding techniques created modern liver surgery, e.g. anatomical subsegmentectomy (today called segmentectomy according to the IHPBA Brisbane 2000 nomenclature) in combination with ultrasound-guided dye injection (Masatoshi Makuuchi, 1984) and Glissonean approach (Ken Takasaki, 1990). Besides these developments, strategies to protect the function of liver remnant were described. In addition, total hepatic vascular exclusion under hypothermic perfusion (Joseph G. Fortner, 1974), ex-situ liver resection (Rudolf Pichlmayr, 1989), anterior approach (Kazue Ozawa, 1990), and liver hanging maneuver for anterior approach (Jacques Belghiti, 2001) were also noteworthy technical innovations