The value of microsurgery in liver research

Abstract

The use of an operating microscope in rat liver surgery makes it possible to obtain new experimental models and improve the already existing macrosurgical models. Thus, microsurgery could be a very valuable technique to improve experimental models of hepatic insufficiency. In the current review, we present the microsurgical techniques most frequently used in the rat, such as the portacaval shunt, the extrahepatic biliary tract resection, partial and total hepatectomies and heterotopic and orthotopic liver transplantation. Hence, reducing surgical complications allows for perfecting the resulting experimental models. Thus, liver atrophy related to portacaval shunt, prehepatic portal hypertension secondary to partial portal vein ligation, cholestasis by resection of the extrahepatic biliary tract, hepatic regeneration after partial hepatectomies, acute liver failure associated with subtotal or total hepatectomy and finally complications derived from preservation or rejection in orthotopic and heterotopic liver transplantation can be studied in more standardized experimental models. The results obtained are therefore more reliable and facilitates the flow of knowledge from the bench to the bedside. Some of these microsurgical techniques, because of their simplicity, can be performed by researchers without any prior surgical training. Other more complex microsurgical techniques require in-depth surgical training. These techniques are ideal for achieving a complete surgical training and more select microsurgical models for hepatology research.

A half century (1961-2011) of applying microsurgery to experimental liver research

“…From the pioneer works of Lee et al [1,[6][7][8] in the early 1960s through today, microsurgery has gained acceptance as an integral component of liver research.…”

“…The techniques of microsurgical dissection are mainly used for performing partial portal vein ligation, extrahepatic cholestasis and hepatectomies [8] .…”

“…The midline abdominal incision is closed in two layers with an absorbable suture (polyglycolic acid) and 3/0 silk. The microsurgical technique allows a better dissection of the portal vein in its initial tract, in which this vein establishes a close adhesion with the proper hepatic artery [8,13] . One of the reasons that the prehepatic PH experimental model presents great evolutionary variability could be based on its inflammatory nature [13,14] .…”

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

“…The serious repercussions of cholestasis on the liver and on the systemic level have led to the creation of many experimental models so as to better understand its pathogenesis, prophylaxis and treatment [146,147]. Obstructive cholestasis causes cirrhotic chronic hepatic insufficiency and portal hypertension.…”

“…To avoid these infectious complications we have proposed performing a microsurgical technique which consists in the resection of the extrahepatic biliary tract [146,147,149]. The use of broad-spectrum antibiotic and vitamin K allows the long-term evolution of the obstructive cholestatic-rats [146,147].…”