Introduction
Pierre-Alain Clavien
Liver surgery was considered until the early 1980s as a “heroic” field of medicine associated with much blood loss, and high patient morbidity and mortality. With such a reputation only life-threatening conditions were usually referred for liver surgery.
As surgeons acquired a better understanding of surgical anatomy and physiology, a better understanding of peri- and intraoperative management, and importantly formal training periods in this field, hepatic surgery began to enjoy rapid expansion and high credibility among colleagues and patients. Today, liver surgery is one of the most complex and successful areas of medicine with the availability of a variety of highly sophisticated procedures for many indications including complex liver resection or transplantation of only one part of the liver from a living donor.
The first chapter presents a comprehensive approach to the terminology of liver anatomy and resection (Brisbane 2000 terminology), according to an international effort including leaders from all continents. The next three chapters present available techniques for vascular exclusion, parenchyma dissection and the “hanging” maneuver, which may enable better exposure for anatomic resections. The hepatic surgeon must be familiar with all these techniques, which may be of great help in many difficult situations. Then, the focus turns to formal anatomic and non-anatomic liver resections, including laparoscopic approaches, which are gaining increasing popularity. As liver resection is often not possible due to local difficult situations (poor liver reserve or location of a tumor) or poor general condition of the patient, alternative techniques are presented including cryosurgery, radiofrequency ablation and selective intra-arterial chemotherapy. Benign and infectious cysts require particular strategies, which are well covered in two separate chapters. A chapter also comprehensively covers the available strategies for liver trauma in the modern area of “damage control injury.” The last six chapters cover various aspects of liver transplantation from organ procurement, to partial living or cadaveric orthotopic liver transplantation, as well as auxiliary liver transplantation.
While there is no substitute for experience in performing complex surgical procedures, we hope that this section, prepared by worldwide experts, will clarify standards and limitations for surgeons in performing hepatic surgery.
