Saving Axle - Life-saving liver lobectomies case 2.
Another liver lobectomy that I performed in the last couple of weeks was for Axle. Axle presented with a hemoabdomen (his abdominal cavity was full of blood). Axle's mass had ruptured and was bleeding. He also required a right-sided (right medial) liver lobectomy as an emergency surgery.
Right-sided liver lobectomies are typically more difficult than left sided liver lobectomies. Surgical resection of right divisional masses are associated with an increased risk
of intra-operative complication when compared to left divisional lobectomies (Moore 2022 abstract). Right liver lobectomies present more of a challenge due to their proximity to the caudal vena cava.
Two Tips:
1 - The rest of Axle's liver had an extremely abnormal appearance. To anyone with limited experience, or even a lot of experience, it could appear like it was full of metastatic neoplasia. It was abnormal in colour, nodular and enlarged. Histopathology (lab analysis) on this was BENIGN. Never diagnose metastasis (spread) in the liver based on gross appearance.
2 - When placing a TA stapler, I always place two fingers (pointer and middle) across the area I wish to staple (this is post any dissection) and clamp down with these two fingers like I would with the stapler THEN I use these fingers to guide the stapler backwards - one finger on each side of the stapler. This ensures I don't entrap any tissue I am not meaning to. I have felt much more confident with this surgery since I have been doing this. Would love to hear anyone else's tips.
Axle's tumor was a well-differentiated hepatocellular adenocarcinoma. These tumors have very long survival times (years) post surgery. We were so pleased for this result and this photo is Axle at his 10 day recheck.