Novel approaches for minimising blood loss during hepatic surgery
Hepatic surgery is a complex surgical procedure that can result in significant blood loss and lead to complications such as postoperative liver failure and the need for blood transfusions. Surgeons have developed several innovative approaches to minimise blood loss during hepatic surgery.
Here are some of them:
- Preoperative embolisation: The surgeon blocks the blood supply to the liver tumour using embolic agents, such as microspheres or gel foam, which reduces the blood flow to the tumour and minimises the amount of blood loss during surgery.
- Intraoperative ultrasound: Intraoperative ultrasound can help the surgeon identify blood vessels and bile ducts in the liver, allowing for more precise surgical dissection and minimising the risk of injury to blood vessels, which can lead to bleeding.
- Pringle manoeuvre: This is a technique in which the blood flow to the liver is temporarily blocked by clamping the portal vein and hepatic artery. This skill reduces blood loss during surgery but must be used with precaution, as prolonged clamping can lead to liver damage.
- Argon beam coagulation: Argon beam coagulation is a technique that uses a beam of argon gas to coagulate blood vessels in the liver, reducing the risk of bleeding during surgery.
- Radiofrequency ablation: Hepatobiliary surgeons use a high-frequency electrical current to heat and destroy liver tumours in radiofrequency ablation. This technique can also help to condense blood vessels and minimise blood loss during surgery.
- Use of hemostatic agents: The surgeon can use hemostatic agents such as fibrin sealants, thrombin, and oxidised regenerated cellulose to control bleeding during hepatic surgery. These agents can promote blood clotting and help prevent excessive blood loss during the procedure.
These novel approaches for minimising blood loss during hepatic surgery can improve patient outcomes and reduce the risk of complications. However, each patient's case is unique. The best approach for minimising blood loss will depend on several factors, including the size and location of the tumour, the patient's overall health, and the surgeon's experience and expertise.
 |
| Happy patient after hepatic surgery |
What is the cause of the disease that may be required?
A hepatectomy, a surgical procedure to remove a portion of the liver, may be necessary to treat various liver conditions. Some causes of diseases that may require hepatectomy include:
- Primary liver cancer, such as hepatocellular carcinoma and cholangiocarcinoma
- Secondary liver cancer, which originates in another organ and spreads to the liver, such as metastatic colorectal cancer
- Benign liver tumours, including adenomas, gallstones in the intrahepatic ducts, and liver cysts
- In a living donor liver transplant, the surgeon removes a portion of the healthy liver from the donor to donate to someone's needy patient a liver transplant during a living donor liver transplant, the size of a healthy liver is removed from the donor and transplanted into the recipient. After the surgery, both the remaining liver in the donor and the transplanted liver in the recipient will regenerate and grow back to its full size.
Surgeons perform partial liver resections to remove cancerous or noncancerous tumours from the liver or as a living donor liver transplant. The goal is to remove the affected portion of the liver while preserving enough healthy liver tissue to ensure proper liver function.
How serious is a liver resection?
Here are some key points to consider about liver resection for living donor liver transplant:
- Living donor liver transplant involves removing a portion of a healthy liver from a living donor to transplant into someone needy patient who requires a liver transplant.
- The surgery removes a portion of the donor's liver, which will regenerate and grow to its full size.
- The recipient's body will also regenerate the transplanted liver to its full size.
- Liver resection is a technically ambitious surgery due to the many vessels in the liver that can bleed. Skilled surgeons must manage any bleeding to ensure safety.
- Skilled surgeons can perform small liver resections (less than half of the liver) using minimally invasive techniques such as laparoscopy or robotic surgery.
- Major liver resections (more than half of the liver) are more dangerous and require experienced specialists due to the complexity of the operation.
How is a hepatectomy performed?
During a hepatectomy, a surgical procedure to remove a portion of the liver, the following steps are typically performed:
- Anesthetisation: Hepatobiliary surgeons give the patient general anaesthesia to ensure they are asleep and won't feel pain during the surgery.
- Incision: The surgeon makes an incision in the abdomen to access the liver.
- Mobilisation: The liver is carefully moved from surrounding structures and blood vessels to make it easy.
- Vascular control: The surgeon identifies and controls the blood vessels that supply the portion of the liver removed by using sutures, clips, or staplers to prevent bleeding.
- Resection: The surgeon removes the diseased or damaged portion of the liver.
- Hemostasis: Various techniques such as sutures, clips, or a device that seals blood vessels with heat to stop bleeding from the remaining liver tissue.
- Closure: The incision is closed using sutures or staples. After the surgery, the patient is closely monitored in the recovery room to ensure they are stable and that their liver is functioning appropriately. After surgery, patients may receive pain management and antibiotics to aid in the healing process.
What happens when doctors remove part of your liver?
After a hepatectomy procedure, in which the doctor removes a part of the liver, the remaining liver tissue compensates for a brief removed portion and undergoes regeneration. Here are some of the things that happen:
- Regeneration: The liver is the only organ in the body that can regenerate itself, meaning the remaining portion of the liver will grow and rebirth to its original size within a few weeks to several months after the surgery.
- Temporary complications: Patients may experience brief development after the surgery, such as pain, fatigue, and a temporary decrease in liver function. However, these usually improve within a few days to weeks after the surgery.
- Long-term outcomes: Most patients who undergo a hepatectomy for cancer have a healthy long-term prognosis if the cancer is caught early and has not spread to other parts of the organs. However, the long-term outcome also depends on the extent of the liver resection, the underlying condition of the liver, and the patient's overall health.
- Lifestyle changes: Patients who have undergone a hepatectomy may need to make lifestyle changes to protect their liver, such as avoiding alcohol, maintaining a healthy weight, and following a balanced diet.
- Follow-up care: Patients can consult regular follow-up care with their doctor after hepatectomy to monitor their liver function and check for any signs of cancer recurrence.
- Depending on the resection size of the liver, liver resection surgery typically takes two to six hours to complete.
What are the risks or complications of liver resection surgery?
Liver resection surgery carries risks and potential complications, which may include:
- Bleeding
- Infection
- Blood clots
- Liver failure
- Bile leakage
- Delayed recovery of liver function
- Respiratory complications
- Adverse reactions to anaesthesia
- Incisional hernia
- Damage to nearby organs or structures
It is crucial to discuss the risks and potential complications with your surgeon before undergoing the procedure.