By Ravish Patel

What do the slinky, chocolate-chip cookies, fireworks, and the transjugular intrahepatic portosystemic shunt (TIPS) all have in common? They were all discovered by accident! It’s hard to think that a medical procedure with such a long name could have been discovered by accident, but sometimes accidents result in some of the best discoveries, such as TIPS (and of course, chocolate chip cookies!).1

The year was 1968. Dr. Josef Rösch was a visiting radiologist at the University of California, Los Angeles (UCLA), where he was performing procedures on canines. He was performing a procedure called a diagnostic transjugular cholangiography, in which the physician drives a catheter and needle from the hepatic vein (see image, light blue) through the liver and into the bile ducts (see image, green). This allowed him to fill the bile ducts with dye which could be visualized on x-ray to see if there was an obstruction or abnormality of the bile ducts.2

During these procedures, the needle would accidentally sometimes enter the portal vein (see image, dark blue) instead of the bile duct.3 While this isn’t what Dr. Rösch had originally intended, this accident eventually led to the invention of the TIPS procedure. He kept in mind what Charles Dotter, one of his mentors who is widely considered the father of interventional radiology, had told him: to always think about potential interventional treatment during diagnostic procedures. With this in mind, Dr. Rösch realized the treatment potential for a connection between the hepatic and portal veins that bypassed the liver.

Patients with liver disease whose portal veins had a hard time draining into the hepatic veins were ideal candidates for such a procedure. Bypassing the diseased liver allowed these patients to reduce the backup in the portal vein and decreased their risk of bleeding in other places, which was a major source of death for these patients.

The original TIPS design has been revised multiple times to culminate in the TIPS procedure of today. Since then, metal stents have been used to open the tunnel between the two vessels. Today, we have stents covered in a chemical that helps keep the lumen patent since the original ones had difficulty staying open for longer than two weeks. This procedure goes to show that keeping an open eye can birth innovation from accident.

Sources:

1. Krueger A. 15 Life-Changing Inventions That Were Created By Mistake. Business Insider. https://www.businessinsider.com/these-10-inventions-were-made-by-mistake-2010-11. Published November 16, 2010. Accessed July 28, 2020.

2. Rösch J. Development of transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol. 2015;26(2):220-222. doi:10.1016/j.jvir.2014.11.011

3. Portal Vein and Hepatic Vein in Liver. Anatomy Note. https://www.anatomynote.com/human-anatomy/blood-supplement/portal-vein-and-hepatic-vein-in-liver/. Published August 11, 2019. Accessed July 28, 2020.