Bengaluru: Planning is half the battle. This was especially true for a city doctor who ensured his patient had a liver affected by cancer regenerated in a jiffy. A week was all it took for the healthy piece of liver to grow into a well-functional one.
A 61-year-old Kenyan patient was suffering from advanced liver cancer complicated by chronic hepatitis B. An innovative technique called Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) ensured rapid stimulation of liver growth and removal of the malignant portion.
Two surgeries took place 10 days apart during which doctors redirected blood flow to a small but healthier part of the 1,450gram liver. Dr Vikram Belliappa, senior consultant, gastrointestinal and liver transplant surgeon, at SPARSH hospital, who operated on the Kenyan, said there are two parts to the procedure.
"First, we had to cut blood supply to the tumoured part of the liver. The patient's condition was complicated as part of the liver (350gm) we'd planned to retain had fibrosis. It was hardened and working sub-optimally. We went back to the drawing board, and the team worked on the entire pre-operative procedure using 3D modelling. The whole surgery was planned after a scan, using 3D imaging and 3D printing at the in-house 3D surgical AI lab, so that exact volumes of the liver could be calculated," he explained.
"Using software and a medical-grade 3D printer, a model of the liver and tumour was created that helped in executing this complex surgery," the doctor added.
Within 10 days of the first surgery, an extended right hepatectomy was conducted to remove the liver's tumour-bearing section. The patient left the hospital a week after surgery and is doing well, Dr Belliappa said.
"Conventionally, liver regeneration takes about six weeks to six months. And if it doesn't grow in time, you run the risk of post-operative liver failure that could set in from days to weeks of the surgery. About 60% mortality is due to post-op liver failure. The method we opted for was the surest way to ensure the patient's quality of life," the doctor added.