First Formal Laparoscopic Hepatectomy Performed at Mediclinic Panorama
Posted on 20 November 2018
The minimally invasive technique, performed by Dr Jonathan Leith, promises to cut down on both theatre and recovery time.
In August 2018, Dr Jonathan Leith and his team at Mediclinic Panorama performed the hospital’s first formal laparoscopic hepatectomy. The patient, 72, who had colon cancer metastatic disease to the liver, was in theatre for under an hour and was discharged the following day.
Liver resection surgery, also known as a hepatectomy, is undertaken in order to remove diseased parts of the liver. Usually, this is necessary after the organ has become affected by the spread of cancer from another organ in the gut region.
“We can remove up to 60% of the liver without ill effects,” says Dr Leith, a specialist surgeon based at Mediclinic Panorama. “The remaining parts of the organ will regenerate to fulfil the function of the parts that have been removed.”
Traditionally, open surgery has been the treatment of choice, and this is regarded as a major operation. “Usually we’d need to make a fairly large incision in order to access the liver, and this takes time, both in theatre and for the patient to recover afterwards. The liver also has a propensity to bleed – if you make a mistake, you can lose a lot of blood very quickly.”
The new laparoscopic approach promises to improve on those outcomes.
Laparoscopic surgery, also known as keyhole surgery, uses far smaller incisions than traditional open surgery. Surgeons then insert a camera into the body via one of these ports and guide their instruments through the cuts.
“The primary goal of surgery, of course, is to cause as little blood loss as possible,” says Dr Leith. “The laparoscopic method helps us to make this procedure as minimally invasive as possible. We can make smaller cuts on the skin, and thereby reduce pain and the risk of a hernia afterwards. We can also see a lot more clearly and be a lot more accurate while inside, and in that way cut down dramatically on how much blood we lose.”
This procedure was performed laparoscopically through five one-centimetre keyhole incisions, and two of the eight segments of the patient’s liver were successfully resected. “For this procedure, we needed one incision for the camera and one each for each of the surgeon’s instruments. We also added one for my assistant’s instrument and a final one for an additional camera.”
By reducing the number and size of the cuts needed to access the liver, this approach causes a lot less trauma for the patient, says Dr Leith. This is why more and more surgeons are turning to laparoscopy as a method to perform accurate, successful and time-efficient liver resection surgeries.
“This successful groundbreaking surgery will form the basis from which our team will build our experience and tackle progressively more technically challenging liver disease utilising minimally invasive techniques in the future,” says Dr Leith.
“Our focus is now shifting towards minimally invasive approaches to accomplish what was traditionally done by open surgery. And this technique, in my opinion at least, is going to become the gold standard for the majority of liver resection surgeries.”