Liver surgery AnatomyHepatectomy Liver tumors BenignMalignant

Liver anatomy

Partial hepatectomy (30-70%) Liver Regenaration Hypertrophy & Hyperplasia (IGF2, HGF) NormaL VS. Cirrhotic liver

Partial hepatectomy (70%) Liver Regenaration Hypertrophy & Hyperplasia (IGF2, HGF) NormaL VS. Cirrhotic liver Anatomical considerations: Adequate Inflow - Portal + Arterial Adequate outflow – Hepatic Vein Adequate drainage - Bile duct

Liver anatomy Anatomical-nonanatomical resection

Liver anatomy Partial hepatectomy

Extended Rt. Hep. Extended Lt. Hep.

LIVER TUMORS Benign Malignant Cystic Solid Primary “" Infectious Parasitic Amaebic Echinococus Bacterial PrinaryMetastatic Cirrhosis

Benign solid liver tumors HemangiomaAdenoma FNH FNH

Liver hemangioma AsymptomaticIncidental Giant Haemangioma Should we operate? Only when symptomatic

Giant hemangioma (I)

Giant Haemangioma (II) Operation

LIVER TUMORS Benign Malignant Cystic Solid Primary “" Infectious Parasitic Amaebic Echinococus Bacterial PrinaryMetastatic Cirrhosis

Liver cyst

Amebic liver cyst

LIVER TUMORS Benign Malignant Cystic Solid Primary “" Infectious Parasitic Amaebic Echinococus Bacterial PrinaryMetastatic Cirrhosis

Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

Fibrolammellar hepatoma Extended Lt. Hep.

Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

Intrahepatic Bile duct cancer Intrahepatic cholangiocarcinoma Adenocarcinoma

Intrahepatic Bile duct cancer Gallbladder cancer

Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

Mesenchymal liver tumors Hemangiosarcoma

Mesenchymal liver tumors Hepatoblastoma PM, 4y male child

Mesenchymal liver tumor Primary lymphoma

LIVER TUMORS Benign Malignant Cystic Solid Primary “" Infectious Parasitic Amaebic Echinococus Bacterial PrinaryMetastatic Cirrhosis

Primary HCC in Cirrhosis No regeneration Major resection – not possible Laparoscopic RF/ Cryo Wedge resection- Possible Liver transplantation Palliative treatment

primary & Metastatic liver tumors LAPAROSCOPIC US NONRESECTABLE RESECTABLE Extrahepatic involvement Confined to liver resection Laparoscopic RF / Cryo ablation

Liver Metastases Optimal treatment – resection

primary & Metastatic liver tumors LAPAROSCOPIC US NONRESECTABLE RESECTABLE Extrahepatic involvement Confined to liver resection Laparoscopic RF / Cryo ablation

Liver Metastases Solitary Resection

primary & Metastatic liver tumors LAPAROSCOPIC US NONRESECTABLE RESECTABLE Extrahepatic involvement Confined to liver resection Laparoscopic RF / Cryo ablation

LAPAROSCOPIC R adio F requency ABLATION PRIMARY & METASTATIC LIVER TUMORS Principles of application Heating to high temperatures O C Single cycle of 12 min. Tumors up to 4cm.

Radiofrequency Interstitial Ablation Clinical Application (II) Percutaneous Open Laparotomy 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 ABLATION Principles of treatment Accurate targeting of lesion Insertion of needle\probe Application ablative technique EfficientHomogenous

Laparoscopic ablation guidance system 10mm. Sectoral ultrasound probe

Laparoscopic US-guided biopsy

LAPAROSCOPIC ABLATION TUMORS OF LIVER Laparoscopic RF ablation system

Radio frequency ablation at laparotomy Local effect

Laparoscopic RF ablation Stages of the Procedure US Targeting Application RF generator End of procedure

CT appearance of Pre+Post LRFA

Laparoscopic liver resection