The advantages of the conservative approach in the treatment of tumors of the liver include protecting the organ as much as possible during surgical oncology in order to minimize the risk of liver failure after surgery and allowing the patient the likeliness of receiving surgical treatment in case of relapse. Today, the chances for cure of patients with primary or secondary liver tumors are more and more consistent, thanks to a targeted surgical technique that uses ultrasound imaging intraoperatively. The use of ultrasound allows accurate assessment of the relationship between the tumor and vessels and analyzes the flows of entry and exit of the blood through the liver. Recognizing all of this has allowed for development of technical solutions which are useful in offering surgery to patients otherwise inoperable.

 

Mini-mesohepatectomy

Mini-mesohepatectomy is an alternative method to the conservative mesohepatectomy, which is a surgical procedure that involves the removal of the central portion of the liver, while drained by the middle hepatic vein. Mini-mesohepatectomy differs in the sense that it entails the sacrifice of the middle hepatic and due to ultrasound study, blood flow within the liver helps reduce the amount of healthy organ that needs to be removed.  

 

 

Tunnel

For tumors that are located in the central area of the liver, hepatectomy (ie the removal of more than half of the liver) is the standard approach. The procedure can be performed from other invasive procedures and help preserve liver tissue as much as possible during surgery, in order to reduce the complications associated with post-operative liver failure (a technique called portal embolization).  If the portion of the liver remaining cannot be reached even through portal embolization, the patient becomes inoperable. The tunnel is the alternative approach to conservative major hepatectomy. This type of procedure constitutes a real “coring” of the organ and makes it possible to minimize the portion of the liver that needs to be removed, all the while removing the entire disease. With the use of this technique, pre-operative embolization is no longer necessary.

 

The tunnel is performed according to two variants, on the basis of the extent of the disease:

  • With preservation of all three hepatic if there is infiltration of the vessels by the tumor

  • By removal of the middle hepatic vein, if this is infiltration by the tumor and if the veins which can take blood from the private portion of the liver vein are recognizable

 

SERPS

SERPS (Systematic Extended Right Posterior Sectionectomy) is the 'alternative approach to conservative right hepatectomy  ie the removal of the right side of the liver, the largest organ. Through the use of ultrasound and evaluation of blood flow, a more conservative resection is possible, taking out only the rear right portion. With this approach, saving the organ is equal to about 20-30% in all cases. 
SERPS has three variations depending on the location of the tumor mass:

  • At the right hepatic vein (location that conventionally involves treatment by right hepatectomy)

  • With involvement stems portals of first and second order spraying the right hemisphere

  • With involvement stems portals of first and second order spraying the right hemisphere, with further dilatation of the bile ducts by tumor

 

 

Upper Transversal hepatectomy

Upper transversal hepatectomy is a conservative approach that involves removing the presence of tumors that affect the right and middle hepatic vein, at their caval confluence. 
Upper transversal hepatectomy involves the sacrifice of only the upper posterolateral liver segments (S7 , S8, 4Sup) together with the two hepatic veins (right, middle) infiltrated by the tumor. The lower segments are preserved by exploiting the presence of the natural by-pass system that allow blood to enter the blood from the only systemic hepatic vein that remains, the left one. 
In the presence of tumor infiltration of the middle hepatic vein set to the left instead of the right, a simple procedure on the organ can be performed. It is a technique that acts an as alternative to hepactectomy measures by decreasing the chances of removing too much healthy tissue which can result in a higher risk of severe liver failure. Before the introduction of the upper transversal hepatectomy, patients with conditions requiring complete operation on the liver were considered completely inoperable.