Surgical Strategies for Liver Disease

The liver is not only the largest organ in the body but also the most complex. It is vital for life. It has a dual blood supply. Surgery on this organ has traditionally fraught with danger. Over the past few years advances in technology and medicine have come together to allow complex operations on this organ with the same mortality and morbidity seen in other simpler operations (eg. Appendicectomy).

The first dramatic advance this century came about when we realized that the liver was in fact formed of 8 individual segments of livers. Hence the concept of segmentectomies came about. That is individual segments could be removed instead of large volumes. This made the operation more difficult for the surgeon to perform but much safer for the patient.

The next advance came in the form of intra-operative ultrasound (ultrasound examination of the liver by special probes during a liver operation). This required again special training of the surgeon. Not only did he have to operate he had to be a radiologist as well.

Technological advances were next. Sophisticated methods of cutting the liver with minimal blood loss came as science progressed. Notably among them were the introduction of the ultrasonic dissector and the harmonic scalpel. These machines use high frequency sound waves to cut and coagulate. This was a revolutionary way of performing surgery. Complex operations could now be undertaken with minimal blood loss. Because of this Liver transplantation developed rapidly and is now established in certain forms of end-stage liver diseases.

Finally over the last 10 years laparoscopic surgery, which was traditionally applied to other abdominal organs, has now been used in selected liver diseases. This minimally invasive approach allows a very rapid recovery. It is still in its infancy as far as liver surgery is concerned and advances will continues. It must still be approached with concern.

The field of Oncology and Hepatology has allowed our understanding of liver disesases to improve tremendously especially with respect to Hepatitis. Working together, oncologists, gastroenterologists and surgeons can now offer treatment for many liver diseases that were deemed untreatable.