Survey
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
Download Liver surgery
Document related concepts
no text concepts found
Transcript
Liver surgery Anatomy Hepatectomy Liver tumors Benign Malignant Liver anatomy Liver anatomy Liver anatomy Partial hepatectomy (3070%) Liver Regenaration Hypertrophy & Hyperplasia (IGF2, HGF) NormaL VS. Cirrhotic liver Partial hepatectomy (70%) Liver Regenaration Hypertrophy & Hyperplasia (IGF2, HGF) NormaL VS. Cirrhotic liver Anatomical considerations: Adequate Inflow - Portal + Arterial Adequate outflow – Hepatic Vein Adequate drainage - Bile duct Liver anatomy Anatomical-nonanatomical resection Liver anatomy Partial hepatectomy Liver anatomy Partial hepatectomy Extended Rt. Hep. Extended Lt. Hep. LIVER TUMORS Malignant Benign Cystic Solid Prinary Cirrhosis "Primary “ Infectious Parasitic Amaebic Echinococus Bacterial Metastatic Benign solid liver tumors Hemangioma Adenoma FNH Liver hemangioma Asymptomatic Incidental Giant Haemangioma Should we operate? Only when symptomatic Giant hemangioma (I) Giant Haemangioma (II) Operation LIVER TUMORS Malignant Benign Cystic Solid Prinary Cirrhosis "Primary “ Infectious Parasitic Amaebic Echinococus Bacterial Metastatic Liver cyst Amebic liver cyst LIVER TUMORS Malignant Benign Cystic Solid Prinary Cirrhosis "Primary “ Infectious Parasitic Amaebic Echinococus Bacterial Metastatic Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal Fibrolammellar hepatoma Extended Lt. Hep. Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal Intrahepatic Bile duct cancer Intrahepatic cholangiocarcinoma Adenocarcinoma Intrahepatic Bile duct cancer Gallbladder cancer Primary liver tumors Cellular component Hepatocellular Bile duct Mesenchymal Mesenchymal liver tumors Hemangiosarcoma Mesenchymal liver tumors Hepatoblastoma PM , 4y male child Mesenchymal liver tumor Primary lymphoma LIVER TUMORS Malignant Benign Cystic "Primary “ Solid Infectious Prinary Cirrhosis Parasitic Amaebic Echinococus Bacterial Metastatic Primary HCC in Cirrhosis No regeneration Major resection – not possible Laparoscopic RF/ Cryo Wedge resection- Possible Liver transplantation Palliative treatment primary & Metastatic liver tumors LAPAROSCOPIC US RESECTABLE NONRESECTABLE Extrahepatic involvement Confined to liver resection Laparoscopic RF / Cryo ablation Liver Metastases Optimal treatment – resection primary & Metastatic liver tumors LAPAROSCOPIC US NONRESECTABLE Extrahepatic involvement RESECTABLE Confined to liver resection Laparoscopic RF / Cryo ablation Liver Metastases Solitary Resection primary & Metastatic liver tumors LAPAROSCOPIC US NONRESECTABLE Extrahepatic involvement RESECTABLE Confined to liver resection Laparoscopic RF / Cryo ablation LAPAROSCOPIC Radio Frequency ABLATION PRIMARY & METASTATIC LIVER TUMORS Principles of application Heating to high temperatures O 80-100 C Single cycle of 12 min. Tumors up to 4cm. Radiofrequency Interstitial Ablation Clinical Application (II) Percutaneous Open Laparotomy Laparoscopic Liver tumors – RFA Indications & contraindications •Liver only disease. •Identified focal tumors. •Ideal diameter< 3cm. •HCC- Cirrhosis. •Compatible performance status. •Complete staging protocol. •Measurable disease (PET,CT,MRI). LAPAROSCOPIC ABLATION Principles of treatment Accurate targeting of lesion Insertion of needle\probe Application ablative technique Efficient Homogenous Laparoscopic ablation guidance system 10mm. Sectoral ultrasound probe Laparoscopic US-guided biopsy LAPAROSCOPIC ABLATION TUMORS OF LIVER Laparoscopic RF ablation system Radio frequency ablation at laparotomy Local effect Laparoscopic RF ablation Stages of the Procedure US Targeting Application RF generator End of procedure CT appearance of Pre+Post LRFA Laparoscopic liver resection
