← All decks
General Surgery
Perspective on Liver Surgery (B)
Built from Maingot's Abdominal Operations
What’s inside
9 sections · 90 slides
Overview
- Topics covered
Resection of Colorectal Liver Metastases
Opening, mapping and naming the operation
- Resection for colorectal cancer spread to the liver
- Incision and exploration
- Intraoperative ultrasound
- Functional division of the liver into segments
- Couinaud's segments
- Named liver resections and the segments removed
- Nomenclature of liver resections
Right Hepatectomy
The most common major liver resection, stage by stage
- Stages of a right hepatectomy
- Mobilisation of the right liver
- Structures exposed at the porta hepatis
- Hepatoduodenal dissection
- Control of the right portal vein
- Demarcation after inflow control
- Intrahepatic control of the right portal pedicle
- Retrohepatic dissection and the short hepatic veins
- Right hepatic vein at the vena cava
- Short veins draining into the vena cava
- Fibrous band caudad to the right hepatic vein
- Division of the right hepatic vein
- Parenchymal transection and the margin
- Finger fracture of the liver parenchyma
- Finger fracture technique
- Pringle maneuver during transection
- Methods of parenchymal transection
- Energy devices for transection
- Vascular staplers for transection
- Cost of the transection methods
- Radiofrequency resection devices
- Drawbacks of radiofrequency resection devices
- Laparoscopic liver resection
- Bleeding control under pneumoperitoneum
- Drainage and recovery
Left Hepatectomy
The mirror image of the right-sided operation
- Left hepatectomy as the mirror image
- Steps of the hilar dissection in left hepatectomy
- Hilar dissection in left hepatectomy, panels A and C
- Hilar dissection in left hepatectomy, panels B and D
- What the hilar panels show
- Caudate lobe and the left hepatic vein
- Completed left-sided parenchymal transection
Hepatic Artery Infusion Pumps
Chemotherapy delivered where the deposits get their blood
- Regional chemotherapy for liver metastases
- Rationale for hepatic artery infusion
- Blood supply of colorectal liver metastases
- First-pass uptake of fluorodeoxyuridine
- Randomized trials of infusion versus systemic therapy
- Complications of infusion pumps
- Indications for hepatic artery infusion
- Multi-institutional trial of infusion chemotherapy
- Trial of infusion after liver resection
- Current use of pump chemotherapy
- Technique of pump implantation
Ablation of Liver Metastases
Destroying a deposit in place, and how it compares with cutting it out
- What radiofrequency ablation does
- Radiofrequency in tumour treatment over time
- How radiofrequency energy heats tissue
- Place of ablation relative to resection
- Anatomical situations that favour ablation
- Routes for performing ablation
- 7%
- Complications of ablation
- Local recurrence after ablation versus resection
- Standing of ablation for colorectal metastases
Benign and Malignant Liver Tumours
Telling them apart, and deciding which ones must come out
- Imaging and the limits of biopsy
- Distinguishing atypical focal nodular hyperplasia from adenoma
- Focal nodular hyperplasia
- Pain and resection in focal nodular hyperplasia
- Hepatocellular adenoma
- Indications for resecting an adenoma
- Open questions about adenoma management
- Adenoma that shrinks below 5 cm
- Adenoma in pregnancy
- Liver adenomatosis
- Regenerative nodular hyperplasia
- Consequences of regenerative nodular hyperplasia
- Hepatocellular carcinoma and the cirrhotic liver
- Portal vein embolization as a test of liver reserve
- Resection margin and bleeding in hepatocellular carcinoma
Cystic Disease of the Liver
Keyhole surgery with the frozen section deciding how far to go
- Symptoms from large liver cysts
- Imaging before treating a liver cyst
- Laparoscopic treatment of a simple-looking cyst
- What the frozen section decides
- Acting on the frozen section result
- Cystadenocarcinoma found on frozen section
Key Points
What to carry away
- Key points on resection
- Key points on the non-resection options
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition