Liver surgery was introduced in the early 50's. This was due to the difficulties faced when dealing with the liver tissue. The liver has a large blood supply, with a rich network of veins and arteries, these can bleed extensively leading to haemorrhages that may be difficult to control. Liver surgery continued to struggle up until the late 80's where mortality rates were around 25%. However, thanks to advances in surgical techniques, improvement of surgical instrumentations and an improved knowledge of the liver tissue and how it behaves, mortality rates have now dropped to less than 3% in recognised centres.
Open liver surgery approach:
- This is the most commonly used approach and until recently was the only one available. This is normally performed through a 15-25 cm long incision in the upper abdomen.
Laparoscopic (keyhole) liver surgery
- The laparoscopic approach has been used since the 1990's for gallbladder, colonic, prostate, renal and other types of surgery. However, due to the difficult nature of the liver, laparoscopic liver surgery has only started in the last ten years and is still limited to very few centres. This surgical approach is hugely used in Southampton. We have the largest UK series and one of the largest worldwide. We have now completed more than 450 liver resections including minor and major resections. We have shown excellent results in terms of mortality rates (1%), morbidity and hospital stay. Having compared the laparoscopic approach with the open approach we proved significant benefits and superiority of the laparoscopic approach. We have published a more than 15 papers in peer review journals (see my publications) and last but not least we run regular well-recognised courses to train HPB consultants from the UK and all over the world in the field of laparoscopic liver surgery.
The laparoscopic approach offers a few advantages including
- 1.Small incisions
- 2.Less pain
- 3.Easier and quicker recovery
- 4.Shorter hospital stay
- 5.Earlier return to work and normal activities
- 6.Fewer postoperative scars and internal adhesions.
However, this is a delicate and complex type of surgery and should be performed only by expert laparoscopic liver surgeons.
Common risks are bleeding, injury to other organs and difficulty in locating the tumours. In these cases conversion to open surgery is mandatory.
Not all liver tumours are amendable to laparoscopic resection. For some tumours such as hilar cholangio carcinoma a laparoscopic approach is not normally undertaken due to the need of extensive lymphoadenectomy (the removal of lymph nodes and lymphatic tissue). In my experience 80% of liver lesions are dealt with by keyhole surgery