Blog Author: George Szasz, CM, MDPosted: Thursday, February 16, 2017 - 10:28
A friend of mine recently had 40% of his liver removed. He is doing well postoperatively but he is getting bored and a bit depressed just resting, not being able to be active for a while. To cheer him up, I told him that it took close to 3000 years between the first historic report on hepatic healing and his bravura surgery. In one version of the tale by Hesiod, a contemporary of Homer in the era of 700 BC, Zeus hid fire from mankind in a fit of temper after Prometheus, a benefactor of mankind, played a trick on him. When Prometheus stole the fire back, Zeus retaliated. He had Prometheus chained to a rock and sent an eagle to pick at Prometheus’s liver. Each day the eagle came back because the liver had regenerated over night. In a happy ending for Prometheus, Hercules slayed the eagle and rescued him.
Today the liver’s regenerative capacity is the basis for modern hepatic surgery. This capacity was first documented by G.M. Higgins and R.M. Anderson about 80 years ago (1931) in research done on rodents. Regeneration is a bit of a misnomer in that the lobes of the liver do not grow back like limbs of some amphibians; instead, mature functioning liver cells proliferate. Much of current research is focused on clarifying what triggers the regeneration and what signals turn it off.
This remarkable physiological feature was not known to the first surgeons performing hepatic surgery. The first planned hepatic resection in the US was done by William W. Keen of Philadelphia in 1891 under ether anesthesia and with Lister’s antiseptic technique. The patient survived but intraoperative uncontrolled bleeding remained the major challenge for surgeons. Over subsequent years the work of anatomists provided guidance for overcoming the threat of this major and potentially lethal complication. The transplantation era began in the 1950s after reports of successful liver transplantation in a dog. In 1963 the team of Dr Thomas E. Starzl made the first attempt at a human liver transplant in Denver, Colorado. The young patient died during the operation—ironically, from uncontrolled bleeding. Dr Bill Wall performed the first liver transplant in Canada in London, Ontario, in 1982. By 1983 advances on many fronts led to the acceptance of liver transplantation as a therapy for patients with end-stage liver disease.
An interesting side note: the perfusion pump required during the procedures was first constructed in the early 1920s by the French surgeon Alexis Carrel and by Charles A. Lindberg, aviator and engineer.
Although my friend did not receive a liver transplant, and his boredom was not lifted by my abbreviated history, he did become more appreciative of the remarkable developments in modern medicine.
—George Szasz, CM, MD
Lehmann K, Clavien PA. History of hepatic surgery. Surg Clin North Am 2010;90:655-664.
Traub R. Liver regeneration: From myth to mechanism. Nat Rev Mol Cell Biol 2004;5:836-847.
This posting has not been peer reviewed by the BCMJ Editorial Board.