liver surgery anatomyhepatectomy liver tumors benignmalignant
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Liver surgeryLiver surgery Anatomy Anatomy
Hepatectomy Hepatectomy Liver tumors Liver tumors
Benign Benign MalignantMalignant
Liver anatomyLiver anatomy
Liver anatomyLiver anatomy
Liver anatomyLiver anatomy
Partial hepatectomy (30-70%) Partial hepatectomy (30-70%) Liver RegenarationLiver Regenaration
Hypertrophy & Hyperplasia Hypertrophy & Hyperplasia (IGF2, HGF)(IGF2, HGF)
NormaL VS. Cirrhotic liverNormaL VS. Cirrhotic liver
Partial hepatectomy (70%) Partial hepatectomy (70%) Liver RegenarationLiver Regenaration
Hypertrophy & Hyperplasia (IGF2, HGF)Hypertrophy & Hyperplasia (IGF2, HGF)NormaL VS. Cirrhotic liverNormaL VS. Cirrhotic liver
Anatomical considerations:
Adequate Inflow - Portal + Arterial
Adequate outflow – Hepatic Vein
Adequate drainage - Bile duct
Liver anatomyLiver anatomy
Anatomical-nonanatomical resection
Liver anatomyLiver anatomyPartial hepatectomyPartial hepatectomy
Liver anatomyLiver anatomyPartial hepatectomyPartial hepatectomy
Extended Rt. Hep .
Extended Lt. Hep.
LIVER TUMORSLIVER TUMORS
Benign Malignant
Cystic
Solid
Primary“ " Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Prinary Metastatic
Cirrhosis
Benign solid liver tumorsBenign solid liver tumors
Hemangioma Hemangioma
Adenoma Adenoma
FNH FNH
Liver hemangiomaLiver hemangioma
AsymptomaticAsymptomatic
Incidental Incidental
Giant HaemangiomaGiant Haemangioma
Should we operate?Should we operate?
Only when symptomatic Only when symptomatic
Giant hemangioma (I)Giant hemangioma (I)
Giant Haemangioma (II)Giant Haemangioma (II)OperationOperation
LIVER TUMORSLIVER TUMORS
Benign Malignant
Cystic
Solid
Primary“ " Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Prinary Metastatic
Cirrhosis
Liver cystLiver cyst
Amebic liver cystAmebic liver cyst
LIVER TUMORSLIVER TUMORS
Benign Malignant
Cystic
Solid
Primary“ " Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Prinary Metastatic
Cirrhosis
Primary liver tumorsPrimary liver tumors
Cellular componentCellular component HepatocellularHepatocellular
Bile duct Bile duct
Mesenchymal Mesenchymal
Fibrolammellar hepatomaFibrolammellar hepatoma
Extended Lt. Hep .
Primary liver tumorsPrimary liver tumors
Cellular componentCellular component HepatocellularHepatocellular
Bile duct Bile duct
Mesenchymal Mesenchymal
Intrahepatic Bile duct cancerIntrahepatic Bile duct cancer
Intrahepatic cholangiocarcinoma
Adenocarcinoma
Intrahepatic Bile duct cancerIntrahepatic Bile duct cancer
Gallbladder cancer
Primary liver tumorsPrimary liver tumors
Cellular componentCellular component HepatocellularHepatocellular
Bile ductBile duct
Mesenchymal Mesenchymal
Mesenchymal liver tumorsMesenchymal liver tumors
Hemangiosarcoma
Mesenchymal liver tumors Mesenchymal liver tumors HepatoblastomaHepatoblastoma
PM , 4y male child
Mesenchymal liver tumor Mesenchymal liver tumor
Primary lymphoma Primary lymphoma
LIVER TUMORSLIVER TUMORS
Benign Malignant
Cystic
Solid
Primary“ " Infectious
Parasitic
Amaebic
Echinococus
Bacterial
Prinary Metastatic
Cirrhosis
Primary HCC in Cirrhosis Primary HCC in Cirrhosis No regenerationNo regeneration
Major resection – not possibleMajor resection – not possibleLaparoscopic RF/ CryoLaparoscopic RF/ Cryo
Wedge resection- Possible Wedge resection- Possible Liver transplantation Liver transplantation Palliative treatment Palliative treatment
primary & Metastatic liver tumorsprimary & Metastatic liver tumors
LAPAROSCOPIC US
NONRESECTABLE RESECTABLE
Extrahepatic involvement Confined
to liver resection
Laparoscopic
RF / Cryo ablation
Liver MetastasesLiver MetastasesOptimal treatment – resectionOptimal treatment – resection
primary & Metastatic liver primary & Metastatic liver tumorstumors
LAPAROSCOPIC US
NONRESECTABLE RESECTABLE
Extrahepatic involvement Confined
to liver resection
Laparoscopic
RF / Cryo ablation
Liver MetastasesLiver MetastasesSolitary ResectionSolitary Resection
primary & Metastatic liver primary & Metastatic liver tumorstumors
LAPAROSCOPIC US
NONRESECTABLE RESECTABLE
Extrahepatic involvement Confined
to liver resection
Laparoscopic
RF / Cryo ablation
LAPAROSCOPICLAPAROSCOPIC R Radio adio FFrequencyrequency
ABLATIONABLATIONPRIMARY & METASTATIC LIVER TUMORSPRIMARY & METASTATIC LIVER TUMORS
Principles of applicationPrinciples of application
Heating to high Heating to high temperaturestemperatures
80-10080-100 O O
CC
Single cycle of 12 min. Single cycle of 12 min.
Tumors up to 4cm.Tumors up to 4cm.
Radiofrequency Interstitial Ablation
Clinical Application (II)
PercutaneousPercutaneous
Open LaparotomyOpen Laparotomy
Laparoscopic 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 ABLATIONLAPAROSCOPIC ABLATIONPrinciples of treatmentPrinciples of treatment
Accurate targeting of lesionAccurate targeting of lesionInsertion of needle\probeInsertion of needle\probe
Application ablative Application ablative techniquetechnique
EfficientEfficient
HomogenousHomogenous
Laparoscopic ablation Laparoscopic ablation
guidance systemguidance system 10mm. Sectoral ultrasound probe10mm. Sectoral ultrasound probe
Laparoscopic US-guided Laparoscopic US-guided biopsybiopsy
LAPAROSCOPIC ABLATION TUMORS OF LIVERLAPAROSCOPIC ABLATION TUMORS OF LIVER
Laparoscopic RF ablation systemLaparoscopic RF ablation system
Radio frequency ablation at Radio frequency ablation at laparotomylaparotomy
Local effectLocal effect
Laparoscopic RF ablationLaparoscopic RF ablationStages of the ProcedureStages of the Procedure
US Targeting
Application RF generator
End of procedure
CT appearance of Pre+Post LRFA
Laparoscopic liver resectionLaparoscopic liver resection