|Surgeon Joseph Kim focuses on gastrointestinal tumors.|
City of Hope surgeons have performed the institution’s first major laparoscopic liver
Joseph Kim, M.D., assistant professor in the Department of Surgery, and his City of Hope team successfully removed a liver tumor on May 2 using minimally invasive surgery, and the patient left the hospital only three days later, significantly faster than the five-to-eight-day hospital stay typical for a traditional procedure.
“She was able to go home off of pain medications; we just provided ibuprofen,” Kim said. He noted that the laparoscopic procedures, which are often dubbed “keyhole surgery,” offer the benefits of smaller incisions and less pain, and usually mean less blood loss, as well.
“The ability to provide a minimally invasive approach to major liver surgery represents a major advance in the treatment of patients with liver tumors,” said Joshua D.I. Ellenhorn, M.D., chief of the Division of General Oncologic Surgery.
As Kim explained, traditional liver surgery involves making a long opening in the skin — called a chevron incision — that runs from one side of the abdomen to the other, just below the rib cage. In the laparoscopic procedure, however, surgeons made four, small incisions.
One incision accommodated a tiny camera, which allows surgeons to see organs on a monitor as they operate. Another two incisions allowed instruments into the body.
The fourth incision — at 4 centimeters wide, the longest of the incisions — was held open using a special device, allowing Kim to use his hand directly in the surgical field. Called handaccess laparoscopy, the technique brings together the traditional art and honed skill of a surgeon with the modern advances of minimally invasive surgery.
During a laparoscopic liver tumor procedure, surgeons carefully resect the tumor and place the tissue in a special bag, called an endocatch, which allows them to remove it from the body without contaminating nearby healthy tissue. In the recent procedure, Kim said, the tumor was benign, but surgeons anticipate using laparoscopic techniques primarily for cancerous tumors.
The surgeons use a special ultrasound probe to make sure they “see” the tumor correctly within the body, he added.
Although the surgery to remove 30 percent of the liver had to be carefully planned, the procedure itself took only two hours, and the patient lost less than 50 milliliters of blood during the operation — a small amount.
The technique is backed by experience, Kim noted. When he was at the University of Cincinnati, Kim worked under Joseph Buell, M.D., a highly regarded liver surgeon who has performed more than 600 laparoscopic liver tumor procedures, the most worldwide. Data from those procedures will be reported later this year.
At City of Hope, surgeons in the Gastrointestinal Cancer Program will evaluate
each patient with liver cancer to see if laparoscopic surgery is appropriate, Kim said; they also will carefully follow recommendations from a surgical consensus conference in autumn that will set international guidelines on the specific use of these laparoscopic resections.
In the future, Kim will work with fellow surgeons such as Alessio Pigazzi, M.D., Ph.D., to study whether the da Vinci Surgical System may be integrated into the surgeries, allowing for robotic minimally invasive procedures. For now, however, Kim and surgical colleagues are enthusiastic about the benefits of laparoscopy.
Said Kim: “We think this can significantly benefit our patients.” About 21,370 cases of liver cancer will be diagnosed in the United States this year, according to the American Cancer Society, while about 18,410 people are expected to die of the disease. The disease is more common in men than in women.