Transcript Liver surgery

Liver surgery
Anatomy
Hepatectomy
Liver tumors
Benign
Malignant
Liver anatomy
Liver anatomy
Liver anatomy
Partial hepatectomy (3070%)
Liver Regenaration
Hypertrophy & Hyperplasia
(IGF2, HGF)
NormaL VS. Cirrhotic liver
Partial hepatectomy (70%)
Liver Regenaration
Hypertrophy & Hyperplasia (IGF2, HGF)
NormaL VS. Cirrhotic liver
Anatomical considerations:
Adequate Inflow - Portal + Arterial
Adequate outflow – Hepatic Vein
Adequate drainage - Bile duct
Liver anatomy
Anatomical-nonanatomical resection
Liver anatomy
Partial hepatectomy
Liver anatomy
Partial hepatectomy
Extended Rt. Hep.
Extended Lt. Hep.
LIVER TUMORS
Malignant
Benign
Cystic
Solid
Prinary
Cirrhosis
"Primary “
Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Metastatic
Benign solid liver tumors
Hemangioma
Adenoma
FNH
Liver hemangioma
Asymptomatic
Incidental
Giant Haemangioma
Should we operate?
Only when symptomatic
Giant hemangioma (I)
Giant Haemangioma (II)
Operation
LIVER TUMORS
Malignant
Benign
Cystic
Solid
Prinary
Cirrhosis
"Primary “
Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Metastatic
Liver cyst
Amebic liver cyst
LIVER TUMORS
Malignant
Benign
Cystic
Solid
Prinary
Cirrhosis
"Primary “
Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Metastatic
Primary liver tumors
Cellular component
Hepatocellular
Bile duct
Mesenchymal
Fibrolammellar hepatoma
Extended Lt. Hep.
Primary liver tumors
Cellular component
Hepatocellular
Bile duct
Mesenchymal
Intrahepatic Bile duct cancer
Intrahepatic cholangiocarcinoma
Adenocarcinoma
Intrahepatic Bile duct cancer
Gallbladder cancer
Primary liver tumors
Cellular component
Hepatocellular
Bile duct
Mesenchymal
Mesenchymal liver tumors
Hemangiosarcoma
Mesenchymal liver tumors
Hepatoblastoma
PM , 4y male child
Mesenchymal liver tumor
Primary lymphoma
LIVER TUMORS
Malignant
Benign
Cystic
"Primary “
Solid
Infectious
Prinary
Cirrhosis
Parasitic
Amaebic
Echinococus
Bacterial
Metastatic
Primary HCC in Cirrhosis
No regeneration
Major resection – not possible
Laparoscopic RF/ Cryo
Wedge resection- Possible
Liver transplantation
Palliative treatment
primary & Metastatic liver
tumors
LAPAROSCOPIC US
RESECTABLE
NONRESECTABLE
Extrahepatic
involvement
Confined
to liver
resection
Laparoscopic
RF / Cryo
ablation
Liver Metastases
Optimal treatment – resection
primary & Metastatic liver
tumors
LAPAROSCOPIC US
NONRESECTABLE
Extrahepatic
involvement
RESECTABLE
Confined
to liver
resection
Laparoscopic
RF / Cryo
ablation
Liver Metastases
Solitary
Resection
primary & Metastatic liver
tumors
LAPAROSCOPIC US
NONRESECTABLE
Extrahepatic
involvement
RESECTABLE
Confined
to liver
resection
Laparoscopic
RF / Cryo
ablation
LAPAROSCOPIC Radio Frequency
ABLATION
PRIMARY & METASTATIC LIVER TUMORS
Principles of application
Heating to high
temperatures
O
80-100 C
Single cycle of 12 min.
Tumors up to 4cm.
Radiofrequency Interstitial Ablation
Clinical Application (II)
Percutaneous
Open Laparotomy
Laparoscopic
Liver tumors – RFA
Indications & contraindications
•Liver only disease.
•Identified focal tumors.
•Ideal diameter< 3cm.
•HCC- Cirrhosis.
•Compatible performance status.
•Complete staging protocol.
•Measurable disease (PET,CT,MRI).
LAPAROSCOPIC ABLATION
Principles of treatment
Accurate targeting of lesion
Insertion of needle\probe
Application ablative
technique
Efficient
Homogenous
Laparoscopic ablation
guidance system
10mm. Sectoral ultrasound probe
Laparoscopic US-guided
biopsy
LAPAROSCOPIC ABLATION TUMORS OF LIVER
Laparoscopic RF ablation system
Radio frequency ablation at
laparotomy
Local effect
Laparoscopic RF ablation
Stages of the Procedure
US Targeting
Application RF generator
End of procedure
CT appearance of Pre+Post LRFA
Laparoscopic liver resection