Less invasive liver surgery safer, speeds recovery
By Ross Tomlin
Liver cancer specialists at Baylor College of Medicine in Houston say a less invasive form of surgery to remove liver tumors helps patients get back on their feet faster.
A practice predominant in parts of Europe but less used in the United States, laparoscopic liver resection – the removal of a diseased portion of the liver using small instruments through tiny incisions – has proved beneficial in more ways than one, said Thomas Aloia, M.D., assistant professor of surgery at BCM.
"You really see the benefit across the board with minimally invasive surgery, particularly when patients are ready to return to work," said Aloia. "Patients undergoing invasive surgery will not be up to doing much for six weeks. The minimally invasive technique cuts that time in half."
Held to a minimum
With conventional surgical techniques, a surgeon must make a wide incision in the abdomen in order to accommodate his hands, scalpel and other instruments. The larger incision takes longer to heal, requiring an extended recovery period.
"Most U.S. programs advocate putting your hand inside (the abdomen) for certain procedures," said Aloia, who learned the less-invasive method when he trained in France. "The novel part of our program is that it is totally laparoscopic."
During a laparoscopy, the surgeon inserts a thin, lighted tube called a laparoscope through a small incision (usually in the abdominal area) to give the doctor a chance to see and evaluate organs or abnormal growths. Using special instruments that can be inserted into that or other small incisions made nearby, the surgeon can remove diseased organs or small tumors.
Because the skin is elastic, the incision for a laparoscopy can be much smaller than the size of the tumor being removed.
"By doing a smaller incision down low where you can stretch the tissues a little more, you avoid having a big scar visible on the upper abdomen," said Aloia. "Having a lower, smaller incision is better tolerated and also minimizes respiratory complications than would an incision close to the lungs."
"There are definite therapeutic and cosmetic benefits," he added.
Liver resection falls into two categories – nonanatomic and anatomic. While the former entails removal of a small portion of the liver, the latter is a more arduous procedure as the surgeon must operate along planes of dissection based on the liver's anatomy.
"Most surgeons can take out small, peripheral things without using their hands," said Aloia. "But when you move into an anatomic resection and step up the level of difficulty, most U.S. programs advocate putting your hand in if you're going to go front to back through the liver on an anatomic plane."
Here to stay
Aloia and John Goss, M.D., professor of surgery at BCM, are part of the liver transplant team within Baylor Liver Health, an interdisciplinary program designed to improve prevention and treatment of liver diseases while conducting basic and clinical research designed to cure them. Goss says the history of laparoscopic procedures, which tend to be less risky and costly than more invasive procedures, bodes well for liver cancer patients.
"It will have the same benefits as any other laparoscopic procedure," said Goss. "It's not just a passing fancy. We will see more of it done all of the time. The better we get at it, the more applications there will be."
So far, patients who have been treated with the less invasive procedure have stayed in the hospital for shorter periods and required less pain medication than patients who had the traditional procedure. However, some patients are not candidates for this kind of surgery.
