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Funcionários do Hospital

Liver Surgery

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Hepatectomy is the surgical removal of part of the liver. It is performed for the treatment of primary liver tumors and liver metastases from other tumors in selected cases (mainly colorectal and carcinoid). The most common contraindications are:

  • Impaired cardiopulmonary function;

  • Severe malnutrition;

  • Impaired liver function;

  • Extrahepatic metastatic disease;

  • Invasion of the portal vein bifurcation or hepatic vein trifurcation;

  • Predicted amount of remaining liver parenchyma < 1% of body weight.

 

How is the surgery done?

Surgery is most often performed through an open approach, through a transverse incision in the upper abdomen, following the curvature formed by the ribs. After inspecting the entire liver and other organs of the abdominal cavity, surgery is started. Blood vessels entering and leaving the liver are isolated. After vascular control, the compromised part of the liver is removed. The need for blood transfusions during liver resection can be reduced using vascular exclusion techniques, controlled hypotension, ultrasonic aspiration, argon coagulation.  At the end of surgery, a drain is left near the surface where the liver was cut, to monitor bleeding and bile leakage.

 

Videolaparascopy or robotic surgery can be used to perform hepatectomy surgery, depending on the location and size of the nodule to be removed (surgery performed through small holes in the abdominal wall with the aid of a video camera and special instruments).

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The use of intraoperative ultrasound can be essential for the correct identification of the location of the nodules during surgery, as well as their relationship with the blood vessels of the liver. Through this examination, new nodules can be identified.

 

How long does hepatectomy surgery last?

The duration of a hepatectomy surgery will depend on several factors such as the location of the liver lesion to be removed (lesion located on the left side of the liver is usually faster), the technique performed (open surgery, videolaparoscopy or robotic surgery). But in general the surgery can take around 2 to 4 hours.

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In the immediate postoperative period, the patient must stay in the ICU (24h) to monitor bleeding and liver function. When stable, return to the bedroom. The diet is started orally on the second or third day after surgery, if the bowel is working. After surgical removal of part of the liver (in a normal liver up to 75% can be removed), it starts to regenerate within 48 hours and reaches near normal size within 4-6 weeks. Function returns to normal in 6-8 weeks. The recovery time will also depend on the technique performed (open surgery, videolaparoscopy or robotic surgery). Typically, minimally invasive techniques provide faster recovery and shorter hospital stay, due to smaller incisions in the abdominal wall and less pain in the postoperative period.

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Among the various possibilities of complications, we can mention the most common:

  • pneumonia;

  • deep vein thrombosis and pulmonary thromboembolism;

  • liver failure;

  • bleeding;

  • “leakage” of bile from the cut surface of the liver;

  • Reoperations may occur.

 

See below the edited video of a left lateral follow-upectomy surgery (tracks 2 and 3) for the resection of a liver tumor with a diagnostic suspicion of liver adenoma. Robotic surgery performed using the Da Vinci Xi system.

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