Why do I need this operation?
You need this operation because it is the most
effective way of removing the tumour(s) in your
What are the likely benefits?
Surgical removal of the tumour(s) offers the only
potential cure.The intended benefit is that the
operation will extend your life expectancy; that
is, you will live longer having had the operation
than if you do not.
How is the operation performed?
Liver surgery is traditionally performed by an
open operation through an incision that often
spreads across both sides of the upper part of
the abdomen.We first disconnect the blood
supply to the part of the liver that carries the
tumour(s).We then cut through the liver using
special devices that help us minimise the blood
loss during the surgery, although sometimes a
blood transfusion may be required.
More recently, liver tumours have been safely and
successfully removed by ‘keyhole’ (laparoscopic)
surgery. However, laparoscopic surgery is not
suitable for all patients.This is for a number of
reasons including, not all tumours can be removed
by laparoscopic surgery, you may have other
medical conditions or you may have had previous
In principle, laparoscopic liver resection is the
same as an open operation, but is performed
through smaller cuts.Whenever we do a
laparoscopic operation, however, there is a chance
that we may need to convert to a traditional open
operation, if faced with a difficulty that we cannot
overcome by laparoscopic surgery.The chance of
a conversion to open surgery may be as high
as 1 in 10 patients (10%). Laparoscopic surgery
is carried out through a few small cuts on the
abdomen, with the use of gas (carbon dioxide)
to inflate the abdomen.The operation is then
performed using a special camera to visualise the
liver, and special instruments. Sometimes, one of
the cuts is made longer than others in order for
the surgeon to place one hand in the abdomen
to help with the surgery (this is called hand-assisted
laparoscopic surgery) and through which the
surgeon finally removes the resected part of
For both types of liver surgery, after the tumours
have been removed a glue-like substance is usually
poured or sprayed onto the liver to help prevent
bleeding after the operation. Everything is carefully
checked and then the incision is closed with several
layers of stitching.
Laparoscopic Liver Surgery
at London Bridge Hospital
Mr Parthi Srinivasan
Before any surgery, open or laparoscopic, the
team will assess your clinical condition and review
your scans to determine how your tumour(s)
could be best removed.All your tests and
scans will be reviewed by a team of doctors
(the multidisciplinary team), which includes
your consultant.The team will recommend the
treatment it feels will be best for you. Obviously,
this recommendation will be thoroughly discussed
with you before a final decision about treatment
If it was not clear from your radiology test or
other scans, whether the tumour is removable,
your surgeon may carry out a diagnostic test called
a laparoscopy (key-hole operation) to evaluate
the tumour further. If this shows that the tumour
has spread outside of the liver or bile ducts, the
surgeon will not carry out the formal resection.
What are the risks?
Some risks are common to all operations, such
as chest infection and blood clots forming in your
veins (DVT) or in the lungs (pulmonary embolus).
However, there are also specific risks associated
with liver surgery:
Bleeding: the liver is well supplied with blood
and one of the major risks of liver surgery
is bleeding.You will lose blood during the
operation and this will be replaced with blood
transfusions as required. Occasionally, bleeding
can occur after the operation and a further
operation may be necessary to stop this.
Specific blood will be kept ready for you,
should you need a transfusion.
Transfusion itself carries some risks and would
not be given, except when absolutely necessary.
If you have any objections to receiving blood
or blood products (such as platelets), it is
essential that you inform your surgeon and/or
anaesthetist before your operation.
Bile leak: the liver can leak bile from where
it has been cut. If your liver does leak bile in
this way, then other procedures may be
required to control this.The reconnections
(or anastomoses) that the surgeon creates
during the operation can sometimes leak,
and if this happens, then further drains (to
drain the leaking fluid to the outside) may
be necessary. If this happens, you may need
to return to theatre for further surgery,
although this is rarely necessary.
Liver decompensation: if your tumour(s) are
large or dispersed within the liver, then a large
part of your liver may have to be removed.
This will leave your body with a much smaller
amount of liver.As explained earlier, in time
this liver will re-grow to take the place of the
liver that has been removed. However, in the
short-term after the operation, your smaller
liver may struggle to do all that it is meant to.
The symptoms of this can be jaundice (your
skin becomes yellow) and a build up of fluid
in your abdomen.These problems will usually
settle down after a week or two. In a very small
number of patients, this may be associated with
other organs not functioning properly, such as
low blood pressure, pneumonia and kidney
Infection: this may involve the wound, the drain
sites or the inner organs.Antibiotics will be given
to you at the time of surgery to try to prevent
an infection developing.
Advanced disease: as noted earlier, sometimes
it is not clear from radiology or other scans
whether or not the tumour is removable. It may
not be until you are actually on the operating
table that it is discovered that the tumour
cannot be removed.
What happens before the operation?
Once surgery has been agreed with you as the
favoured option, you will be asked to attend a pre-
assessment clinic to assess your fitness for surgery
and answer questions.This usually takes half a day;
during this, the operation will be explained in detail
and informed consent will be taken from you for
the procedure.An anaesthetist will explain the
anaesthetic process and discuss the post-operative
pain relief options.This is usually in the form of
epidural analgesia, where a small tube is inserted
into your back to deliver the pain relieving drugs.
Alternatively, a patient control analgesia pump (or
PCA) will be offered.A PCA allows you to control
your own dosage of pain relief, delivered through
a drip in your arm, by pressing a small button.
Please use this opportunity to ask the surgeons,
nurses or anaesthetists any questions that you have.
On admission, you will be given information about
the expected date of your discharge from hospital.
This is to help you, and the staff caring for you, to
plan and prepare for your return home.
The day before the operation, you must not eat
or drink anything after midnight as your stomach
needs to be as empty as possible for the general
anaesthetic you will be given for this operation.This
may be given to you when you are in the operating
theatre itself, so don’t worry if you are still awake
when you are first taken into the theatre.
A liver resection is an
operation to remove a part
of your liver. It is usually
performed because the liver
has one or more tumours in
it.The liver is one of the few
organs in the body that is able
to re-grow. Up to 80% of the
liver can be removed, and the
healthy liver will re-grow in
approximately 8-12 weeks.
If you have any further queries, please do not
hesitate to contact me on:
020 7234 2730
Mr Parthi Srinivasan, Consultant Liver and
Pancreatic Surgeon, London Bridge Hospital.