ABSTRACT
The anatomic approach to liver resection is a modern development, but its underpinnings stretch back many years. The remarkable regenerative capacity of the liver was prefigured in classical times by the story of Prometheus, whose liver was mythically able to regenerate daily after being devoured by an eagle. For many years, it was recognized that humans could survive with significant destruction of the liver due to amebic cysts, abscesses, and traumatic injury. However, the potential for significant hemorrhage from the liver was also recognized, and fear of such hemorrhage precluded safe resection. Thus, a surgical understanding of the structure and function of the liver is a development of modern times. One of the earliest reports of liver resection was by J.C. Massie in 1852. He described a 7-year-old boy who sustained a gunshot wound and subsequently herniated a portion of the right lobe of his liver through a defect in the abdominal wall. When this segment became gangrenous, the abdominal wall defect was enlarged, and a significant portion of the right lobe was removed. The patient ultimately recovered after this operation. The first elective liver resection was reported by Carl Langenbuch in 1888. He resected 370 g of the left lobe of the liver in a 30-year-old female with abdominal pain. Interestingly, this patient required early re-exploration for hemorrhage from the remaining liver, but subsequently recovered well. The modern understanding of the segmental anatomy of the liver was described by Couinaud in 1957 and serves as the basis for contemporary segmental liver resections. Advances in surgical techniques of liver resection were devised in the 1950s and 1960s by surgical pioneers such as Lortat-Jacob, Quattelbaum, Longmire, Fineberg, and McDermott. These improvements in technique – extrahepatic
vascular control, parenchymal division with ligation of intrahepatic structures, and occlusion of the portal triad – allowed liver resections to be performed with an increased level of safety and ushered in the contemporary era of hepatic surgery.
