Ton That Tung, a pioneer in hepatic surgery

Among the icons of hepatic surgery, Dr. Ton That Tung of Vietnam holds a special place. He was one of the first surgeons in the world to understand the anatomy of the liver and its surgical implications, culminating in a large series of hepatic resections in the 1960s.

Ton That Tung was born in 1912 and grew up in Hué, Vietnam (1,2). He studied medicine at the École de Médecine de l’Indochine in Hanoi, then the only medical faculty in Vietnam under French direction. Although the colonial government did not allow local medical students to enter postgraduate training programs, Ton That Tung by standing up to that ban, was admitted to the Phu Doan Hospital in Hanoi. He continued his surgical training at this hospital, which was renamed Viet-Duc Hospital in 1956, where he would work for the rest of his professional life as head of the surgical department and director of the hospital.

During his residency at Phu Doan Hospital, he studied the internal anatomical structures of the liver by dissecting 200 livers obtained from human corpses. He dissected the vascular and biliary structures using a knife and fine curette and also made corrosion casts of the portal and hepatic vasculature in the liver, long before Couinaud and Rapp used this technique in the 1950s, in Paris and Montpellier, respectively (3). In 1939, he graduated with a prize-winning dissertation on the venous vascularization of the liver, laying the foundation for a lifelong dedication to anatomical segmentation of the liver and hepatic resection.

In 1939, encouraged by his in-depth anatomical studies of the liver, Ton That Tung together with his mentor Prof. Meijer-May, performed a formal left hepatectomy. This was the first report of an anatomical hemihepatectomy, predating the first anatomical right hemihepatectomy published by Lortat-Jacob in 1952 at the Beaujon Hospital in Paris. Ton That Tung used the finger-fracture technique to transect the liver parenchyma and pioneered the transhepatic Glissonian pedical approach and intraparenchymal division of the hepatic veins in hepatic resection.

Dr. Ton That Tung worked in extremely difficult conditions in a country that was torn apart by wars, in the 1950s against French colonial rule and in the 1960s, the war in North and South Vietnam involving US military forces. During these wars, Ton That Tung continuously provided medical care at the frontlines. Despite the turmoil of the wars, Ton That Tung managed to write and publish in 1962, a textbook on hepatic resection, entitled Chirurgie d’Exérèse du Foie (Surgery of hepatectomy) (4) (Figure 1). He described the finger-fracture method he had introduced for dissecting the liver parenchyma, combined with clamping of the hepatic pedicle and controlled hypotension to reduce blood loss. To prevent ischemic injury to the liver during clamping, he applied general hypothermia induced by immersing the anesthetized patient in a chilled water bath. The intubated patient was cooled for approximately 1 hour until the target temperature of 30 ℃ was reached. The patient was then placed on the operating table and surgery commenced.

Figure 1 Ton That Tung’s photograph and book illustration. (A) Photograph of Ton That Tung, 1962. In his left hand, he holds part of a corrosion cast of the liver. Photograph provided by Vietnam Society of HBP Surgery. (B) Illustration from Ton That Tung’s book, Chirurgie d’Exérèse du Foie [1962], showing the intrahepatic segmental distribution of the portal vein. The numbers of the liver segments were adopted from Couinaud’s classification. Modified from Fig. 23 in Chirurgie d’Exérèse du Foie [1962] (4).

Ton That Tung became world famous for his original concepts in liver anatomy and his longstanding experience in hepatic resection. In his hospital, the Viet-Duc Hospital today, there is a permanent exhibition commemorating the life and work of Ton That Tung, a surgeon remembered not only for his pioneering achievements in hepatic surgery, but more importantly in Vietnam, as a patriot who laid out the medical foundations of his beloved country.

Acknowledgments

The author wishes to thank Dr. Le Van Thanh, President of the Vietnam Society of HBP Surgery for providing the photograph of Ton That Tung (Figure 1A) and Dr. John Tinnemans for his valuable information on Ton That Tung at the Viet-Duc Hospital.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, HepatoBiliary Surgery and Nutrition. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2025-20/coif). T.M.v.G. serves as an unpaid Deputy Editor-in-Chief of HepatoBiliary Surgery and Nutrition. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Josee NG. Professor Tôn Thất Tùng: Patriotic Liver Surgeon & Author Of World-Class Medical Advancements. 2021. Available online: https://thesmartlocal.com/vietnam/ton-that-tung-surgeon/
2. Helling TS, Azoulay D. Ton that Tung's livers. Ann Surg 2014;259:1245-52. [Crossref] [PubMed]
3. Bonnel F, Duparc F. Historical anatomy of hepatic segmentation: about 250 livers corrosions by Rapp (1953) and Couinaud (1953) in the Conservatory of Anatomy in Montpellier. Surg Radiol Anat 2020;42:1407-20. [Crossref] [PubMed]
4. Ton That T. Chirurgie d’Exérèse du Foie. Paris: Masson & Cie; 1962. Author's collection.