[Inaudible].
Liver resection means removing a portion of the liver that may contain
a, either benign or malignant tumor.
And depending on the type of tumor that we're removing and the location,
this will determine how much liver needs to be removed and how we do the
operation. Based on the anatomy of the liver,
we do a lot of preoperative planning with our advanced
imaging techniques and in collaboration with our radiology colleagues
to ensure that we can effectively remove a portion of liver or
resect that portion of liver,
while leaving behind enough liver to sustain the patient and
ensure that they have a safe and effective operation.
First in anatomy lesson,
this is a diagram of the functional liver anatomy,
where you can see the liver is divided into different segments.
And these segments are determined by the blood flow that goes to,
and from these specific portions of the liver,
this looks very complicated, which it can be in some cases,
but the precise anatomic description of the liver has allowed us to perform
very precise surgeries,
where we can take out a tumor from a portion of the liver and leave a
good, healthy, functional liver remnant behind.
And this is very important because liver failure after liver resection can
be very dangerous for patients.
So you can see from this diagram that the left liver
is composed of segments, two, three,
and four. So this is the left liver.
And for example,
if there is a tumor sitting here in this part of the liver,
based on the anatomy of the liver with the blood vessels
that go in and out of this portion of the liver,
we can do a very precise liver resection,
where we cut the liver here and minimizing any bleeding
complications,
remove this entire segment of liver with the
tumor and ensuring a negative margin and a good oncologic outcome
for the patient.
So the right liver contains segments five,
six, seven, and eight.
The right liver is larger than the left liver,
where it encompasses approximately two thirds of your liver volume.
And so when we have a tumor located the right lobe of the liver,
for example,
in this location and have to remove the right liver,
there are other techniques that we may use to ensure that
the left liver has enough volume to sustain the patient
after removing the right side of the liver.
And these techniques may include radiology procedures
to ensure that the left liver has enough blood supply after a major
liver resection.
So if a tumor is located here in the center of the right lobe,
we may need to remove all of this portion of the liver or
all of the right side of the liver to ensure that that tumor comes out
safely and with a negative margin between the tumor and the
cut edge of the liver.
So it's critical that a liver surgeon has a very precise
and deep understanding of liver anatomy to ensure that when we do a liver
resection, we can do it safely for the patient,
but also ensure that the tumor comes out with a good margin and the patient
gets a good oncologic outcome. After liver resection.
There are.
For a variety of benign and malignant liver conditions that may
require liver resection. Some benign liver tumors,
for example,
have a bleeding risk where if they are left untreated,
they can cause a significant problem for a patient.
And those tumors can be removed by liver resection,
offering a curative therapy for those patients.
And there are a variety of malignant tumors,
both primary liver cancers, um,
and metastatic liver cancers to the liver that can be cured by liver
resection. Uh, in many cases,
Liver resection starts with preoperative planning and the planning
revolves around ensuring that the,
the patient will be able to have a good outcome based on the location of their
liver tumor. And specifically,
we look at the anatomy of the liver to ensure that we can perform a safe
operation in that we minimize bleeding and other
complications during the resection remove the portion of liver
with the tumor or whatever the condition may be and ensure that the
liver remnant left behind is healthy and will sustain that patient through
the perioperative period. Um, and all of this begins with anatomy.
We study our radiology scans and work with our radiology
colleagues, very closely to ensure we have a good understanding of that.
Patient's liver anatomy here is a schematic
of a normal patient's liver anatomy.
And importantly,
there are several blood vessels structures and bile ducts that go into
the liver, specifically the hepatic artery,
the portal vein. And you can see here in green, the bile duct,
and the way that we do a liver resection is we very
carefully identify these structures and divide the structures
that are going towards the portion of liver that we may be removing.
So, for example, when we are removing the left side of the liver,
we will divide these structures that go into the left
side of the liver shown here.
The last part of the operation is dividing the blood vessels that drain that
segment of the liver. So again,
with the example of the left liver resection,
after we've divided the blood vessels that go to the liver,
we divide this vein that drains this portion of the liver.
And that's essentially how we do a liver surgery.
Again,
the understanding of the anatomy is extremely important to being able to
provide a safe operation for patients. And again,
our goal is to minimize complications and ensure that the patient has a good
oncologic outcome
Section has inherent risks,
that center primarily around bleeding problems.
And in some cases, liver insufficiency,
which can even lead to liver failure in rare cases,
the risk of bleeding is probably the,
the most common thing that we deal with as liver surgeons and up
to one and 10 or 10% of patients may need a blood transfusion either during or
after a liver resection. Um,
there are strategies that we use to try to
mitigate or prevent, um, liver failure,
liver insufficiency from occurring after liver resection. Um,
and we used advanced technologies,
including things like embolization of a portal vein
to try to enhance the liver remnant
or the piece of liver that's left behind so that it can regenerate optimally
after liver resection and reduce the risk of liver failure or
liver insufficiency. Um,
the third risk with liver resection has to do with the bile ducks.
When we cut through the liver,
not only do we cut through blood vessels and control those,
but there are also bile ducts,
which are tubes that drain bile from your liver into your intestine.
And those also need to be controlled. And sometimes those can leak, um,
after the surgery, that's typically not a life threatening condition,
um, but may require an additional procedure to treat
Vantage of coming to MedStar Georgetown transplant Institute is that you
get a multidisciplinary approach to your liver condition that may or may
not require a liver resection.
We have a team of experts in surgery and oncology,
gastroenterology, um, radiation oncology,
and hepatology that all come together and make sure that
you get the best possible care that you have all
medical and surgical options available to your liver condition. Um,
and if you need liver surgery,
we have experts in both minimally invasive and open liver
surgery, um,
that really gives you all options for, um,
care of your liver condition.