A gentler look at liver surgery
Because of the blood vessels that supply the liver, it can be a complex organ on which to operate. City of Hope surgeons, though, recently made liver surgery a little gentler — by performing the institution’s first major laparoscopic liver tumor surgery.
Joseph Kim, M.D., assistant professor in the Department of Surgery, and his City of Hope team successfully removed a liver tumor using minimally invasive surgery, and the patient left the hospital only three days later, significantly faster than the typical five-to-eight-day hospital stay.
photo: Paula MyersSurgeon Joseph Kim focuses on gastrointestinal tumors.
“She was able to go home off of pain medications; we just provided ibuprofen,” Kim said.
Laparoscopic procedures, which are often dubbed “keyhole surgery,” offer the benefits of smaller incisions and less pain, and usually mean less blood loss, as well, he noted.
“The ability to provide a minimally invasive approach to major liver surgery represents a major advance in the treatment of patients with liver tumors,” said Joshua D.I. Ellenhorn, M.D., director of the Division of General Oncologic Surgery.
Traditional liver surgery involves making a long incision that runs from one side of the abdomen to the other. In the recent laparoscopic procedure, however, surgeons made four small incisions instead.
One incision accommodated a tiny camera, which allows surgeons to see organs on a monitor as they operate. Another two incisions allowed instruments into the body.
The fourth and largest incision — only 4 centimeters across — was held open using a special device, allowing Kim to use his hand directly in the surgical field. The technique brings together the traditional art and honed skill of a surgeon with the advances of minimally invasive surgery.
In the procedure, the surgeons also use a special ultrasound probe to make sure they “see” the tumor correctly within the body, he added.
Although planning for the surgery to remove 30 percent of the liver was extensive, the procedure only took two hours, and the patient lost little blood during the operation.
Surgeons in City of Hope’s Gastrointestinal Cancer Program will continue to evaluate each patient with liver cancer to see if laparoscopic surgery is appropriate, Kim said; they also will carefully follow international guidelines on the use of these laparoscopic resections, expected to be set this fall.
In the future, Kim will work with fellow surgeons to study whether surgical robots may be integrated into the minimally invasive procedures. For now, however, Kim and surgical colleagues are enthusiastic about the benefits of laparoscopy.
Said Kim: “We think this can significantly benefit our patients.”