Bloodless liver resection for a patient with bile duct cancer using CUSA technique

Which is the Best Treatment for Liver Resection on Bile Duct Cancer?

14th June, 2018


About a year back a 64-year-old gentleman presented at Manipal Goa with recurrent cholangitis and uncontrolled diabetes. He was diagnosed with papillary renal cancer in the past, which was successfully removed by the Urologist at MHG.

On evaluation, he was found to have cholangiocarcinoma involving left hepatic duct with multiple cholangiolytic abscesses in the left lobe of the liver.

After optimization, left hepatectomy and hilar lymphadenectomy was successfully done using the CUSA machine at MANIPAL – a machine specifically designed for liver parenchymal resection.

The surgery took 12 hours to perform followed by 5 days stay in Intensive Care for further recovery.

The patient is now doing well and could successfully fight 2 cancers.

The CUSA Technique and its Benefits

Hepatic resection is a surgical procedure of great challenge because of the risk of massive bleeding during a liver transaction and the complicated biliary and vascular anatomy in the liver. The history of the development of surgical techniques of liver resection is largely a struggle against haemorrhage from the liver transaction.

If you have localized liver cancer or another liver disease that requires a liver resection, a “bloodless” liver resection offers a much safer alternative to traditional surgery. The liver receives blood from two major sources — a large vein coming from the intestines and a large artery — which makes it challenging for any surgeon to make incisions using traditional methods. When the traditional method is performed, as many as five to 10 units of blood or more are needed. The “bloodless” resection technique has changed all of that.

Instead of using a scalpel, a device called a cavitational ultrasonic surgical aspirator, or CUSA, which uses ultrasonic waves to aspirate (suction out) liver cells, is used, leaving behind only a skeleton of blood vessels. A second tool called a TissueLink is a probe that streams hot, sterile water from its tip to coagulate the liver’s blood vessels, sealing them upon contact. Combining these tools reduces surgical time by nearly half (only two to four hours with the “bloodless” method, contrasted with the four to six hours of a traditional resection). The technique also confines any tissue damage to a much smaller area than if a scalpel had been used.

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