What is the liver? And what does it do? The liver is a large organ that is situated in the right upper part of the abdomen. It has a rich blood supply and carries out many functions, which include making blood clotting factors and proteins, getting rid (detoxification) of harmful substances that enter the blood from the bowel, and breaking down red blood cells.
Why am I having part of my liver removed? Your tests show that there is a tumour(s) on the liver. Surgery to remove the part of the liver containing the tumour(s) appears possible. If the tumour is thought to be or was shown (by a biopsy) to be cancerous (malignant), then a liver resection may offer you the only chance of cure. Liver resection is also sometimes required if it is not clear whether the tumour is benign or not, or if it is causing you problems.
Can I live without part of my liver? We can survive normally with only one-fourth or even one-fifth of our liver, provided that the remaining liver is healthy and free of disease. If the liver is diseased, resection of liver can be a problem.
The remaining liver re-grows (regenerates) after surgery and it usually does so within 4-6 weeks. It may not however return to its full original size.
How may the surgery be performed? The surgery is traditionally performed by an open operation through an incision that often spreads across both sides of the upper part of the abdomen. We first disconnect the blood supply to the part of the liver that carries the tumour(s). We then cut through the liver using special devices that help us minimise the blood loss during the surgery. Sometimes a blood transfusion may be required.
More recently, liver tumours have been removed safely by ‘keyhole’ (laparoscopic) surgery, and our initial experience with this approach has been successful. Not all tumours can be removed by laparoscopic surgery. Your scans will help us determine whether your tumour(s) could be removed by laparoscopic surgery.
Laparoscopic surgery is carried out through a few small cuts on the abdomen, with the use of gas (carbon dioxide) to inflate the abdomen. The operation is then performed using a special telescope and special instruments. Sometimes one of the cuts is made longer than others in order for the surgeon to place one hand in the abdomen to help with the surgery (this is called ‘hand-assisted laparoscopic surgery’) and through which the surgeon finally removes the resected part of the liver.
In principle, the laparoscopic ‘liver resection’ is the same as the open operation, but is performed through smaller cuts. Whenever we do a laparoscopic operation, however, there is a chance that we may need to convert to a traditional open operation if faced with a difficulty that we cannot overcome by laparoscopic surgery. The chance of a conversion to open surgery may be as high as one-in-ten patients (10%).
What are the risks of the open operation? Liver resection is a major surgery and, like other major operations, carries a risk to life and risk of complications. Some one-quarter to one third of patients may have a complication after the surgery that delays their discharge from hospital. These may include complications ‘specific’ to the liver surgery and ‘general’ complications.
The liver surgery complications may include bleeding, leakage of bile, collection of infected fluid at the site of the removed liver (abscess), or jaundice (yellowish discolouration of the eyes and skin). Liver failure rarely occurs, and is more of a risk in people with liver disease. General complications that can be associated with any major surgery include wound infection, chest infection, urine infection, fluid collection on the chest (pleural effusion), heart problems, and clots in the legs (deep vein thrombosis; DVT).
If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months or years later.
The risk of death due to a complication is 5% or one chance in 20. Most people having open surgery will be in hospital for 10 to 14 days.
What are the benefits of the ‘keyhole’ surgery? ‘Keyhole’ (laparoscopic) surgery involves smaller cuts, requires only minimal tissue handling and causes less trauma to adjacent normal organs. This means less pain after the surgery, which makes it easier and quicker for you to get up and about after the operation. This decreases the risk of general complications of surgery. Hospital stay will be shorter as a result (average of 3-5 days).
What are the risks of the ‘keyhole’ surgery? The liver surgery complications are the same as for open surgery. Rarely, one might accidentally make a hole in the bowel when putting the first port (a ‘port’ is a short tube through which the surgeon passes instruments into the abdomen to do the surgery) in the abdomen. The chance of that is less than one in 300; and this is something that we can repair laparoscopically. In all laparoscopic surgery there is a very small risk of gas entering the blood stream causing a problem with the circulation, which is treatable. To make this complication less likely we use low pressure gas.
How experienced are we with keyhole surgery? There has been a few hundred of this operation performed worldwide in selected patients with favourable results. Our experience with laparoscopic liver resection at Manchester Royal Infirmary is currently limited to three patients. All procedures were completed laparoscopically without a need to convert to an open operation, and all three patients made a smooth and rapid recovery and were discharged from hospital within 1-3 days of surgery. Although our experience with laparoscopic liver resection is -at present- limited, we have a good experience in complex laparoscopic surgery, and take all the safety precautions needed to make your operation go as smoothly as possible.
