The most convenient cutaneous incision is parallel to the arch of the false ribs, one or two finger-breadths below, ten to fifteen centimetres in length, starting at the right parasternal line for the right lobe, and at the median line, swerving to the left, for tbe left lobe. Kousnetzoff and Pensky (Rev. de Chir., Dec., '96).
As a means of lnemostasis, the tempo rary digital compression of the pediele of the liver is proposed. The method of procedure is as follows: The left index fing,er is introduced through the foramen of Winslow and compression by the thumb of all the structures of the pedicle. Tuffier (Gaz. kiebdom. de Med. et de Chir., Jan. 28, '97).
}hemorrhage forms the serious danger which makes the extirpation of malig nant tumors of the liver very perilous. Itontier (Univ. Med. Jour., Feb., '97).
In resection of the liver it is recom mended to apply to the liver around the portion to be removed a series of inter locked ligatures of thick silk. Each in dividual ligature, after being crossed with its fellow to the right and left, is slowly and steadily tied with snell firm ness that the liver-parenchyma is cut, but the vessels are retained undivided in thc loop. When the whole series of liga tures are tied then the vessels are to be severed by the knife or scissors. It is of importance while transfixing the liver to 'lie little force, and when any slight ob stacle to the passage of the instrument is etwountm:ed, to manipulate the -needle from side to side. and so gently guide it past the obstruction.
The points of transfixion ought to be about one centimetre apart. In experi ments on dog.s no difficulty has ever been met N‘ith, and the wound in the liver has nen er bled in the slightest degree, either primarily or secondarily.
It might be well in excising portions of the liver to make the wound wedge shaped, so that. heemostasis having been obtained by ligatures. the wound might be made less extensive by means of sutures passed from side to side. .M. Auvray (Revue cle Chin, Apr., '97).
The best procedure in treating liver wonnds after removal of tumors is to use a rubber tube for .a tourniquet, if neces sary to tie all large vessels separately, using press.ure for the oozing; to close the liver as much as possible with sutures; to drop the stump and to sur round it completely with sterile gauze, packing iodoform gauze against the liver wounds, and leave the abdominal wound sufficiently open to facilitate dressing the liver-wound. Elliott (Annals of Surg.,
July, '97).
Successful extirpation of a large caver nous angioma of the liver. Its origin was from the lower surface of the left lobe by a broad attachment. Pfannen stiel (Allg. Med. Central-Zeit., Feb. 19, '98).
Case in which left lobe of the liver con tained a growth. A double temporary ligature of catgut was put around the portion of the liver to be reseeted. Then, while strong, traction was made, a ten tative cut was made in the liver. The vessels were drawn and ligated as the resection proceeded. A large piece of the liver was thus resected without any hamorrhage. A large piece of sterilized rubber ti.ssue was placed on the intestines and a piece of gauze against the raw sur face of the liver. These were removed in a few days. The patient's general condition improved markedly. H. Lilien thal (Med. Record. Oct. 22, '98).
Analysis of 76 cases of resection of the liver for hepatic neoplasms. The tenni nation in the ease of 2 patients, was un certain; of the remaining 74, 63 recov ered, the operative mortality thus being, 14.0 per cent. Shock, hemorrhage, and exhaustion caused death in S instances; septicemia in 2, and pulmonary embo lism in 1. Four-fifths of the patients were females, this proportion being attributed to tight lacing. Echinococcie and hy datid cysts were found in 20 instances; carcinoma in 17; syphiloma in 2; ade noma in 7; sarcoma in 5, and rarer forms of new growth in single instances. An early exploratory eteliotomy advocated in every ease. Keen (Annals of Surgery, Sept., '99).
Hmmostasis of the liver. Experiments dog.s showed that in wonnds 4 by 3 centimetres, plugging alone was suffi cient. In resections (involving, 30 to 40 grammes) plugging alone was not always safe, but combined with isolated ligature of the vessel it was satisfactory, Digital compression of the hepatic hilum was useful as a temporary measure. Tricomi (II Policlinic°, Sept. 15, *99).