Page 11 - index
P. 11

What do you do when you need a lot of liver? (part 2)
➤ Continued from Page 10

be necessary before placement in some Figure 3 Use of the ligasure handpiece to
instances. rapidly remove vascular adhesions to a large
Electrosurgical instruments may also hepatic mass without blood loss.
be used to complete partial liver lobec-
tomies or to provide additional hemosta- considered lethal. Portal hypertension
sis during dissection. Bipolar radiofre- or endotoxemia from decreased Kuppfer
quency vessel sealing devices such as cell activity can occur after extensive
the Ligasure system use a high electric hepatectomy. For this reason, post-oper-
current and low voltage along with a ative antibiotic therapy is recommended
system of measuring tissue impedance following liver lobe surgery. Liver cir-
to use the bodys own collagen and elas- rhosis, prolonged biliary tract obstruc-
tin to create a permanent fusion zone. tion and hypoalbuminemia may also be
These instruments are rated to provide present and can all decrease tolerance
adequate hemostasis for vessels up to to hepatectomy. Fortunately, hepatic
7 mm in size, however caution must be regeneration does occur following hep-
used when near thin walled vessels such atectomy. It usually begins within 24
as those found in hepatomas, hemangio- hours and peaks 72 hours after surgery.
mas and other types of tumors. Acoustic Regeneration occurs via hyperthrophy
instruments such as the Harmonic scal- and hyperplasia and can restore liver
pel may also be used for dissection, how- volume within 6 weeks.
ever they are rated for closure of smaller Removing large segments of liver
vessels (~3 mm). These instruments are tissue can be a scary prospect. Fortu-
rarely adequate for complete ligations, nately with recent advances in surgical
especially in larger patients. Additional equipment and post-operative care,
primary ligation of the main hepatic ves- even large lesions can be removed rela-
sels with sutures or stapling equipment tively safety. Regardless of the tech-
is required to complete the lobectomy. nique used, meticulous hemostasis and
Recently several delivery systems for ligating of hepatic tissue can be complicated when appropriate care can provide good outcomes
sutures and staples have been adapted for use multiple lesions are encountered. In general, for animals with extensive hepatic lesions.
with minimally invasive surgical equipment, any lesions that are actively bleeding should When you encounter large liver lesions in your
expanding its use with hepatic resection. be removed. It has been reported that a 70% patients, do not hesitate to contact us for infor-
The decision to remove a large segment hepatectomy can be tolerated while 84% is mation on options for your patients. o

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