LAPAROSCOPIC LIVER RESECTION
Chevron incision in open liver surgery
The most frequent incision utilized to open the abdomen for liver surgery is called a chevron incision. In this incision a cut is made on the abdomen below the rib cage. The cut starts under the armpit below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite arm pit thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches.
This is one of the longest incisions is utilized in abdominal surgery. The incision is frequently associated with significant discomfort after the surgery and in some patients the discomfort can continue for many months, particularly when some of the nerves in the abdominal wall have been cut during the surgery.
Laparoscopic surgery provides advantages over open surgery for the liver since the chevron incision is completely avoided and the surgery is performed through tiny incisions. As a consequence the duration of stay in hospital, the amount and duration of post operative discomfort, and the length of recovery is much shorter after the laparoscopic procedure compared to open surgery
Laparoscopic liver resection (removal) procedures performed at USC
We have developed laparoscopic procedures for liver resection. These procedures avoid the large chevron incision used in open liver surgery. Laparoscopic liver resection allows patients to go home earlier and recover quicker compared to open procedures.
The liver resection procedures offered at USC are
Laparoscopic wedge resection of the liver
In a wedge resection of the liver the tumor is removed with a surrounding margin of about half inch of normal liver. Wedge resection of the liver is preferred since only small amounts of liver tissue is removed during this procedure. A wedge resection is an option only for those tumors that are situated on the surface of the liver so that they can be safely removed without injury to the blood vessels of the liver. Cancers that are situated deep in the liver cannot be safely removed with a wedge resection due to a very high risk of injury and uncontrolled bleeding from the blood vessels within the substance of the liver.
Traditionally wedge resections have been performed through an open surgery , laparoscopic surgery was limited for the liver since removal of only the most superficial tumors was possible.
With the availability of hand-assisted laparoscopic surgery we are now able to perform a wedge resection on any part of the liver as long as the tumor is present on the surface of the liver. All the different parts of the liver are easily available to us for surgery.
We also perform an intraoperative examination of the liver with an ultrasound probe during laparoscopic surgery to better stage the tumor and detect additional tumors that may have not been seen in the X-rays studies performed prior to the surgery.
Lateral segmentectomy of the liver
The left lobe of the liver has two components: a medial segment and a left lateral segment. The left lateral segment of the liver is often involved with metastatic disease and may require removal. In some patients the tumors may be confined only to the left lateral segment. Under these circumstances removal of the left lateral segment may provide an opportunity for cure.
The left lateral segment traditionally is removed through a large chevron opening. We offer a laparoscopic approach to removal of the left lateral segment. During this procedure small incisions are made for a video chip camera and laparoscopic instruments. In addition to that we make a two inch incision to place a new laparoscopic device called the hand port. The placement of a laparotomy hand-access device allows insertion of the surgeons hand into the abdomen for retraction and dissection of the liver from its surrounding attachments
web site provides select information about pancreatic and biliary disorders
and is updated twice monthly. This information is not intended as a substitute
for professional medical consultation with your physician.It is important
that you consult with your physician for detailed information about your
medical condition and treatment.The center will make every effort to update
the site, however, past performance is no guarantee of future medical