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Liver surgery for patients with a large liver tumour using a sonopet ultrasonic aspirator

Segmentectomy – the dissection of the part of liver with a tumour – is recognised as the optimal treatment option to eliminate a liver tumour. However, this procedure requires the transection of the liver, an organ considered to be the largest blood tank of the body due to its complicated network of blood vessels and bile ducts

Consequently, this procedure involves considerable blood loss and even life-threatening risk. Typically, the bigger the liver tumour that invades the blood vessels and surrounding organs, the larger the risk of bleeding. Currently, most of the world’s large liver surgery centres are using an ultrasonic aspirator – a versatile system for precise liver recession and a higher degree of safety, specifically in terms of significantly decreasing the risk of bleeding and bile duct damage.

FV Hospital’s General Surgery Department has performed many successful surgeries using this device in many liver cancer cases, especially those involving large liver tumours

Mr. D., 54, was admitted to FV Hospital as he suffered from weight loss and a sensation of a full abdomen, both of which was caused by advanced liver cancer. He had a huge tumour 12 cm in diameter on the left side of his liver and another 15 cm tumour in the middle of his liver. These tumours had invaded the blood vessels inside his liver and become involved with other organs located outside the liver.

In this case, surgery was the only option to save Mr. D’s life.

SUPPORTING TECHNIQUES USED TO REMOVE LARGE LIVER TUMOURS

Historically, a liver tumour measuring 10 cm in size is considered a very large tumour and surgery a challenging procedure. In Mr. D’s case, which involved a 12 cm tumour that had invaded the hepatic blood vessels and external organs, surgery was a risky option. However, surgery was the only way to save his life.

Following many multidisciplinary consultations and profound consideration of Mr. D’s condition, the available equipment and facilities at FVH and the skilled clinical personnel at FV Hospital, Dr Phan Van Thai, key surgeon in charge of this patient, decided to perform the surgery as soon as possible.

The procedure started with a long incision through the patient’s abdomen. Utilising the special surgical instruments available in the operating theatre, the surgical area was approached and exposed to optimally facilitate the surgical procedure. Then . Thai decided to apply the technique first described by well-known Japanese Professor Takasaki, i.e. clamping the portal pedicle from the hepatic hilar to identify clearly the parts of the liver for dissection and the ones to remain.

This advanced technique enabled the liver dissection process to be performed with greater accuracy and a notable decrease in the risk of post-surgical bleeding. The period of time during which hepatic anaemia may have occurred was minimised by clamping the portal pedicle supplying blood to the dissected part of the liver without clamping the portal veins to the healthy liver tissues. This technique minimised the risk of fatal, post-surgical complications of liver failure and significantly decreased the risk of cancer recurring following treatment.

The following step was to transversely cut the liver to remove the part with the tumour. This step also involved the highest risk of serious bleeding and damage to the bile duct. Dr Phan Van Thai used a Sonopet Ultrasonic Aspirator to perform this vital step. Due to the precise controls of the Sonopet Ultrasonic Aspirator, the patient lost a small amount of blood – less than 10 ml – and no damage was caused, even to the smallest blood vessels or bile ducts following the liver transection.

All invasive tumours were also removed from the surrounding organs. After four hours, the half of the liver that contained tumour tissue was removed completely. The surgery ended in success without any complications.

UTILISING A SONOPET ULTRASONIC ASPIRATOR FOR LIVER SURGERY

The Sonopet Ultrasonic Aspirator is a versatile system for precisely controlling the dissection of soft tissue and fine bones in three distinct stages:fragmentation, irrigation and aspiration.

During fragmentation, tissues are removed by rapid longitudinal motion, which operates in the same way as ultrasound waves (25 KHz) with an extremely small vibration amplitude, creating a powerful energy to emulsify the tissues at the tip of fragmentation while anhydrous tissues remain unaffected. In liver surgery, this ultrasonic aspirator is controlled at a level of power sufficient to emulsify liver tissue without affecting the blood vessels and bile ducts.

Consequently, liver tissues on the cutting path are turned into emulsible, which is then, via irrigation and aspiration, removed immediately, clearly exposing blood vessels and bile ducts for surgeons to either dissect or to preserve.

There are many benefits in using this instrument for liver recession in liver cancer treatment, such as the complete and precise removal of a tumour without touching the surrounding healthy tissues and damaging the smallest blood vessels. This results in a significant decrease of risk in post-surgical bleeding and shortens the recovery period for the patient.

Dr. Phan Van Thai noted additionally: “With the equipment and facilities available at FV, the application of the advanced Takasaki method and utilisation of the Sonopet Ultrasonic Aspirator have eased the challenges posed by liver segmentectomy.

“Mr. D. recovered well following surgery – his liver functions were almost unaffected and his body responded positively to treatment. His stay in ICU was less than 24 hours, whereas other cases have had to stay in ICU for many days.

“Two days after the surgery, Mr. D can stand up and enjoy a meal.”