1. Liver surgery AnatomyHepatectomy Liver tumors BenignMalignant

2. Liver anatomy

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

6. 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

7. Liver anatomy Anatomical-nonanatomical resection

8. Liver anatomy Partial hepatectomy

9. Extended Rt. Hep. Extended Lt. Hep.

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

11. Benign solid liver tumors HemangiomaAdenoma FNH FNH

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

13. Giant hemangioma (I)

14. Giant Haemangioma (II) Operation

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

16. Liver cyst

17. Amebic liver cyst

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

19. Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

20. Fibrolammellar hepatoma Extended Lt. Hep.

21. Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

22. Intrahepatic Bile duct cancer Intrahepatic cholangiocarcinoma Adenocarcinoma

23. Intrahepatic Bile duct cancer Gallbladder cancer

24. Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal

25. Mesenchymal liver tumors Hemangiosarcoma

26. Mesenchymal liver tumors Hepatoblastoma PM, 4y male child

27. Mesenchymal liver tumor Primary lymphoma

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

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

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

31. Liver Metastases Optimal treatment – resection

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

33. Liver Metastases Solitary Resection

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

35. LAPAROSCOPIC R adio F requency ABLATION PRIMARY & METASTATIC LIVER TUMORS Principles of application Heating to high temperatures 80-100 O C Single cycle of 12 min. Tumors up to 4cm.

37. Radiofrequency Interstitial Ablation Clinical Application (II) Percutaneous Open Laparotomy Laparoscopic

38. 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).

39. LAPAROSCOPIC ABLATION Principles of treatment Accurate targeting of lesion Insertion of needle\probe Application ablative technique EfficientHomogenous

40. Laparoscopic ablation guidance system 10mm. Sectoral ultrasound probe

41. Laparoscopic US-guided biopsy

42. LAPAROSCOPIC ABLATION TUMORS OF LIVER Laparoscopic RF ablation system

43. Radio frequency ablation at laparotomy Local effect

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

45. CT appearance of Pre+Post LRFA

46. Laparoscopic liver resection