High Tech Surgery Safely Removes Cancerous Livers

Armen Hareyan's picture
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Transplant surgeons at Thomas Jefferson University Hospital in Philadelphia are using a new method called "bloodless" liver resection to safely remove up to 75 percent of the largest organ in the human body. The technique is improving patients' odds and cutting recovery time in half.

Cataldo Doria, M.D., Ph.D., director of the Division of Transplantation at Jefferson, and associate professor of Surgery at Jefferson Medical College, has performed hundreds of liver procedures. But Dr. Doria's two newest surgical tools are making a remarkable difference for patients with localized liver cancer and other liver diseases because they enable the extraction of cancer tissue while preventing blood loss.

"Patients are having such a speedy recovery because there is next to no blood loss with this new procedure," says Dr. Doria, who helped to develop the technique. "That's why we call it 'bloodless'. Our goal is to eliminate the need for transfusion."

The number of Americans diagnosed with liver cancer has doubled in the last decade, with new cases of primary liver cancer continuing to increase. According to the American Liver Foundation, over 80 percent of primary liver cancer cases in the U.S. are linked to cirrhosis, or scarring, of the liver, which is predominantly caused by hepatitis C (HCV), hepatitis B (HBV) and alcohol abuse. Chronic infection with HBV (without cirrhosis) and obesity are the two other leading risk factors for liver cancer.

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Surgical resection is generally the best treatment option for patients with localized liver cancer. However, the liver receives blood from two major sources-a large vein coming from the intestines and a large artery-which makes it challenging for any surgeon to make incisions using traditional methods. When they do, a patient may need as many as five to 10 units of blood or more. But the new "bloodless" resection technique has changed all of that.

Explains Dr. Doria, "The liver is similar to a sponge full of blood, and cutting it in the traditional sense is complex because major bleeding can occur. With this new method there is no cutting. We are able to suck out the liver's cells and seal off the blood vessels immediately."

Instead of using a scalpel, Dr. Doria is now using a device called a cavitational ultrasonic surgical aspirator, or CUSA, which uses ultrasonic waves to aspirate (suction out) liver cells, leaving behind only a skeleton of blood vessels. Another surgeon follows Dr. Doria with a second tool called a TissueLink. This probe streams hot, sterile water from its tip to coagulate the liver's blood vessels, sealing them upon contact. Combining these tools reduces surgical time by nearly half (only two to four hours with the "bloodless" method, contrasted with the four to six hours of a traditional resection). The technique also confines any tissue damage to a much smaller area than if a scalpel had been used.

With the new "bloodless" liver resection, patients are generally up and walking 24 hours after surgery, remain in the hospital only five to seven days (compared with 10 to 14), are back to regular activities in two weeks (as opposed to four ) and completely recovered in one month. Up to 75 percent of a patient's liver can be removed safely with this technique. The resected liver can regenerate to its original size in two to three weeks.

Source: Thomas Jefferson University Hospital

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