General Liver Surgery
Our Liver Transplantation and Surgery Team provide a variety of options for conditions that affect the liver and biliary tract. These options include:

• Liver resection
  Every patient with a liver tumor should be evaluated for a liver resection that will rid the body of the cancer and prevent further spread to other regions. Hepatocellular carcinoma and cholangiocarcinoma are tumors that originate in the liver. Other reasons for liver resection are metastases from other sites such as breast, kidney, lung, selected tumors of the pancreas and small intestine and sarcomas. In general, any patient with a liver “mass” should be carefully screened for a possible resection; in fact, many benign tumors may become malignant if not treated.

  To remove a tumor in the liver, surgeons often need to remove the tumor and a portion of the liver. Because the human liver can actually regenerate (re-grow), up to 70% of the liver can be safely removed during a liver resection. That is, as long as no scar tissue has formed. Liver surgeons can now design a “road map” prior to surgery which provides critical information that will be used to make the operation safer. Instead of examining the liver at the time of the surgery, essential information could be gathered ahead of time with CT scans, MRI, ERCP (Endoscopic Retrograde Cholangiopancreatography) and vascular radiology. These are all the ways that surgeons learn details about the exact location of the lesion in the liver and of the surrounding vessels (veins and arteries).

  For patients who may not have enough liver reserve, surgeons use a procedure called “hepatic intrarterial chemo-embolization,” which increases blood flow to the liver. In this procedure, interventional radiologists inject chemotherapeutic agents directly into the artery that is “feeding” the liver tumor. This allows large doses of cytotoxic agents to be delivered directly to the tumor site (sometimes with a dramatic response). This helps to spare the patient some of severe side effects, such as nausea and hair loss, that are typical of traditional chemotherapy.

  Liver resection may be performed laparoscopically, using minimally invasive techniques, or using open surgical methods. The choice depends on a variety of factors, such as the type of tumor and location, among other things.

• Removal of stones within the liver
  Stones in the gallbladder are called “silent” if no symptoms are detected. Nevertheless, they often migrate into the neck of the gallbladder or into the common bile duct, causing obstruction and infection. Sometimes the acute attack subsides spontaneously. Eventually, a surgery may be necessary if it is confirmed that stones have been found in the common bile duct.
• Liver Biopsy
  Physicians perform liver biopsies to learn more about the health of a patient’s liver. Often, a blood test or an X-ray suggests that a patient’s liver is not working properly. During a biopsy, physicians remove a small piece of tissue (the size of a needle) from the liver. This tissue is then examined under a microscope. This gives doctors the best chance to learn whether the liver is healthy or what is causing the problem.

  Often, prior to a liver biopsy, physicians use ultrasound to locate the liver and to help guide the needle to the exact spot where they will remove the tissue.

  Needle biopsy. Usually, liver biopsies are performed by needle. Patients are given a local anesthetic to numb the area where the needle will be inserted. This usually takes less than 10 minutes.

  Laparoscopic biopsy. Sometimes, when surgeons need to biopsy several areas of the liver, they may perform a laparoscopic biopsy. A laparoscope is a special tube that sends images to a monitor and contains surgical instruments. The tube is inserted through an incision in the patient’s abdomen. The surgeon watches the monitor and uses the surgical instruments to remove the tissue samples.

  Transvenous biopsy. When patients have blood-clotting problems or tend to have fluid in their abdomen, physicians use “transvenous biopsy.” Physicians insert a tube called a catheter into a vein in the patient’s neck and guide it to the liver. An interventional radiologist then puts a biopsy needle into the catheter and then into the liver.