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Techniques in Liver Surgery
  1. E R HOWARD

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    Techniques in Liver Surgery. Edited by Mazziotti A, Cavallari A. (Pp 369; illustrated; price not given.) London: Greenwich Medical Media (distributed by Oxford University Press), 1997. ISBN 1 900151 251.

    The first formal right hepatectomy was reported by Lortat-Jacob and Robert in 1952. Before that time surgeons tried to steer clear of liver surgery because of the risk of uncontrollable haemorrhage and the operative mortality rate of at least 20%. However a widening knowledge of segmental hepatic anatomy described by Couinaud in 1957, and elaborated by Bismuth in 1982, led to the development of safe resectional techniques for the various major segments of the liver so that intraoperative deaths have become rare events in elective liver surgery. The techniques of hepatobiliary surgery have developed rapidly and the subject is now recognised as a subspecialty in its own right to encompass very advanced procedures such as transplantation from living, related donors, split liver transplantation and neonatal liver replacement.

    This book (dedicated to the memory of Professor Gozzetti of Bologna) is an atlas of every type of surgical technique applicable to liver surgery and is based on the work of the surgical department in Bologna over more than 15 years. A brief summary of current concepts of hepatic anatomy is followed by descriptions of the standard methods of liver resection as well as the more unusual and difficult operations designed to resect single segments such as the caudate lobe (segment 1), segment 4 or segment 8. Other topics include total vascular occlusion of the liver, which is a very valuable surgical technique for extensive tumours, intraoperative ultrasound, portal embolisation and the management of trauma. The surgery of cystic disease of the liver and tumours of the bile ducts is included and almost one third of the volume is devoted to a comprehensive review of the techniques of liver transplantation. I appreciated the inclusion of discussions on possible technical complications in many of the sections, especially as the authors detail the methods of management. These comments are valuable and extremely useful for any newcomer to liver surgery.

    As a minor criticism I would have preferred the more general sections of the text to have been grouped at the beginning of the book to form an introduction to the chapters concerned with specific resectional techniques. It seems a little unusual to describe and illustrate all of the standard operations before introducing a discussion on the general principles of liver resection in section 14, and the indications for liver resection in section 18.

    Throughout the text there are references to the results of the various operations, but these are, of necessity, rather restricted in scope and the reader would have to refer to other texts for further data.

    The superb quality of the illustrations, produced in the department of anatomy in Bologna, provides the outstanding feature of this book, although it was a little disappointing to find that the section devoted to the resection of tumours of the extrahepatic bile ducts was not illustrated in the same manner and the intraoperative photographs used in this chapter lack the clarity of the illustrations in the other sections.

    A potential purchaser of a book on liver resection can now choose from a wide range of texts but in my opinion this book should be high on the list. The technique of illustration avoids the simplification of the more usual type of line diagram and avoids the lack of clarity which often accompanies the reproduction of intraoperative photographs. It really does give a good impression of the “feel” of liver surgery and does not avoid discussion of the potential hazards. Furthermore although the book was designed primarily as a manual for liver surgeons I am sure that any gastroenterologist with an interest in liver medicine would appreciate the illustrations both as an extremely useful guide to the current surgical repertoire of liver surgery and as an extremely fine example of the art of the medical illustrator.

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