Two Stage Extended Liver Resection

Two-Stage Extended Liver Resection (TAMLAPS)

Some patients are referred to our practice with enormous liver tumors or multiple liver tumors occupying/replacing most of the liver, requiring resection of more than 70% of the total liver volume. These patients are at risk of developing postoperative liver failure because they will not be left with adequate functioning liver parenchyma to support their metabolism after the extended resection.

At least 30% of healthy functioning liver parenchyma must remain after resection to avoid postoperative liver failure. Traditionally, a portal vein embolization by an interventional radiologist is done to embolize the ipsilateral portal vein going into the tumor side. This maneuver will also induce contralateral liver hypertrophy (growth) in about 6-8 weeks. This procedure is successful in about 70% of cases. In the other 30%, the contralateral liver fails hypertrophy. To mitigate this, we have adopted a two stage extended liver resection technique, known as ALPPS procedure (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy).

Contact Dr. Iswanto Sucandy for Reliable Two Stage Hepatectomy

In our liver cancer program, we modified two stage hepatectomy under a stringent review board protocol to increase its safety and renamed it TAMLAPS (Tampa Associating Microwave Liver Ablation and Portal Vein Ligation for Staged Hepatectomy). We also incorporated a minimally invasive robotic technique in this operation to decrease postoperative complications and shorten postoperative recovery.

During the first stage, a robotic diagnostic examination of the abdominal cavity and the liver is undertaken. After excluding tumor spread within the abdomen, we undertake a robotic portal vein ligation and liver partition using a microwave ablation system. About 2-3 weeks later, the contralateral liver segments hypertrophy significantly to greater than 30%, reducing the chance of liver failure after extended resection.

A special CT scan protocol with a volumetric rendering method is obtained to document the percentage of liver hypertrophy. At the second stage, the extended liver resection removing the liver tumor(s) with curative intent is then completed.

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Tampa
(813) 615-7030

iswanto.sucandy@adventhealth.com

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Brandon
(813) 278-8850

iswanto.sucandy@adventhealth.com

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Treatments

Robotic Liver Resection

Dr. Iswanto Sucandy and his team work collaboratively with their multispecialty partners to undertake liver resection in a minimally invasive fashion because of its known clinical advantages and long-term positive oncologic outcomes. Minimally invasive liver resection is recommended based on tumor location, size, proximity to major vascular and biliary structures. The vast majority of all liver resections in our liver surgery program are performed minimally invasively using the Da Vinci robotic system...See More..

Open Liver Resection

In about 15% of patients, minimally invasive liver resection cannot be offered mainly due to tumor size, location, and proximity to or involvement of major vascular/biliary structures. An open liver resection, the conventional way of undertaking a liver operation is then indicated. A surgical retractor is placed to properly expose the liver and the tumor, away from other abdominal organs such as stomach, intestines, and colon. Most patients stay in the hospital for 5-6 days after an open liver resection...See More..

Two-Stage Extended Liver Resection

Some patients are referred to our practice with very large liver tumors or multiple liver tumors occupying/replacing most of the liver, requiring resection of more than 70% of the total liver volume. These patients are at risk of developing postoperative liver failure because they will not be left with an adequate functioning liver parenchyma to support their metabolism after the extended resection. To avoid postoperative liver failure, at least 30% of healthy functioning liver parenchyma must remain after resection...See More..

Repeat Liver Resection

New tumors can arise after a liver resection via either open or robotic method. Many patients with this condition are candidates for a repeat liver resection in combination with systemic chemotherapy administration. For colorectal cancer with liver metastases, repeat liver resection has been well documented to increase overall survival. Some patients achieve survival more a decade after the index metastatic diagnosis....See More..

Laparoscopic/ Robotic Liver Ablation For Liver Tumor

Local therapy with thermal ablation is a secondary alternative treatment option for various liver tumors in patients who are not suitable for liver resection. Marginal liver reserve, the need to remove excessive amount of normal liver in order to clear a small tumor (<3cm), and patient’s inability to tolerate major operation due to medical issues are the most common reasons to recommend ablation instead of liver resection.....See More..

Laparoscopic Liver Biopsy

Not every liver tumor needs a liver biopsy to confirm diagnosis. However, in many circumstances, a diagnosis to confirm tumor type/subtype and to guide further treatment is unable to be made without a tissue sampling. Percutaneous CT-guided or ultrasound-guided liver biopsy by an interventional radiologist is the most common way of obtaining liver biopsy. When the liver tumor is located on the left side of the liver, an endoscopic liver biopsy can also be done as an alternative method. ...See More..

Laparoscopic Liver Cyst Unroofing

Laparoscopic liver cyst unroofing is done to treat symptomatic large hepatic cysts. Percutaneous liver cyst aspiration by an interventional radiologist is well known to fail in more than 90% of patients due to rapid fluid reaccumulation within the hepatic cyst. Therefore, percutaneous liver cyst aspiration should not be offered as a treatment option due to its futility. To definitively treat symptomatic large hepatic cysts, removal of a large portion of the cyst wall is mandatory. ...See More..

Robotic Biliary Resection & Reconstruction for Biliary/ Liver Cancers

Robotic biliary resection is needed to cure bile duct cancer located outside the liver. Seldomly, benign bile duct pathology manifesting in biliary stricture is managed with biliary resection. A small percentage of liver cancers also require biliary resection when the main bile duct is involved by the cancer. A loop of small intestine is utilized to reconstruct the biliary system and to reestablish biliary flow....See More..

Robotic Bile Duct Repair

Bile duct leak can be caused by many reasons such as an inadvertent injury of the bile duct during a difficult laparoscopic cholecystectomy, trauma (stab or gunshot wound), or a large gallstone impinging on the bile duct wall causing a pressure necrosis phenomenon (Mirizzi syndrome). However, the most common reason for bile duct leak is from laparoscopic cholecystectomy. Dr. Iswanto Sucandy and his team is the referral destination for bile duct leak/injury following a laparoscopic cholecystectomy in Tampa Bay Area....See More..

Robotic Gallbladder Cancer Resection

The standard surgical treatment for gallbladder cancer includes central liver resection to remove part of liver segment 4 and 5 as well as anatomical excision of the regional lymph nodes along the bile ducts. Thorough examination of the liver is mandatory to exclude presence of hepatic metastasis from the gallbladder cancer. In many centers, only open operation is offered due to lack of expertise in minimally invasive surgical method....See More..

Robotic Exploration Of Bile Duct

Surgical exploration of the bile duct to remove debris or stones causing obstructive jaundice is needed when endoscopic or percutaneous approach fails. Traditionally, this operation is done through an open approach. In the area of minimally invasive surgery, exploration of the bile duct can be done without creating a large open incision to minimize postoperative complications. During the exploration of bile duct, a small endoscope is inserted into the bile duct to visualize the debris or stones... See More..

Laparoscopic Cholecystectomy

Gallbladder pathology commonly presenting as right upper quadrant abdominal pain/discomfort after meals, nausea, vomiting, and colicky epigastric pain is the most common cause of needing gallbladder removal. Laparoscopic cholecystectomy is a very common procedure done by general surgeons. This procedure is very well tolerated by patients. A small percentage of patients experience temporary diarrhea or loose bowel movements (1-2 weeks) and long-term side effects of cholecystectomy are almost nonexistent... See More..

Two-Stage Extended Liver Resection (TAMLAPS)

Contact Dr. Iswanto Sucandy for Reliable Two Stage Hepatectomy

Tampa (813) 615-7030

Brandon (813) 278-8850

Schedule A Consultation With Dr. Iswanto Sucandy, MD

Treatments

Tampa
(813) 615-7030

Brandon
(813) 278-8850

Schedule A Consultation
With Dr. Iswanto Sucandy, MD