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Historical evolution of hypothermic liver surgery
N Yamanaka1, C L Dai, E Okamoto
1First Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
World Journal of Surgery
|September 25, 1998
Summary
Hypothermia in liver surgery has evolved from whole-body cooling to advanced in situ perfusion techniques. These methods aim to reduce ischemia-reperfusion injury and intraoperative bleeding during hepatic procedures.
Area of Science:
- Surgical Innovation
- Medical History
- Organ Preservation
Background:
- The historical application of hypothermia in surgery began with treating congenital heart defects and open-heart procedures.
- Hepatic hypothermia was developed to mitigate ischemia-reperfusion injury during liver surgery involving inflow occlusion.
Observation:
- Early methods like body surface and extracorporeal cooling for hepatic hypothermia faced limitations due to adverse effects on other organs.
- In situ cold hepatic perfusion emerged as a viable option in 1971, followed by in situ hypothermic hemihepatic perfusion in 1995 to protect the non-operated lobe.
- Topical ice slush cooling, introduced in 1993, offers a simpler alternative without complex perfusion equipment.
Findings:
- Various hypothermia techniques have been developed for liver surgery, each with specific benefits and technical considerations.
- In situ perfusion and topical cooling represent advancements in minimizing hepatic ischemia and bleeding.
Implications:
- Liver surgeons must weigh the advantages and complexities of different hepatic hypothermia strategies.
- Continued development in hypothermia aims to improve patient outcomes by reducing surgical complications.