Right Hepatectomy

Right hepatectomy surgery

A major liver resection is called right hepatectomy, during which a portion of the liver (segments V, VI, VII and VIII) is excised on the right. It is usually done as a form of treatment to tumors or extreme liver disease, with keeping a sufficient amount of healthy liver tissue intact.

The liver is subdivided into functional parts. In right hepatectomy, the surgeons will remove:

• Right hepatic lobe
• Right hepatic artery
• Right portal vein branch
• Right hepatic duct

(and still maintaining the left-sided structures)

The remaining left liver is slowly regenerated and the lost part is replaced.

Indications (Why It Is Done)

Right hepatectomy can be advised in case of:

• Liver hepatocellular carcinoma.
• Liver metastases (colorectal cancer in particular)
• Large benign tumors 
• Cholangiocarcinoma 
• Liver trauma
• Liver transplantation: Living donor.

Types of Right Hepatectomy

• Open right hepatectomy
• Right hepatic laparoscopic hepatectomy.
• Extended right hepatectomy (segment IV in case of dissemination of the disease)

Laparoscopic right hepatectomy

This is a novel hepatobiliary operation in which the right hepatic lobe is removed with preservation of the left lobe by small keyhole incisions. The regenerative capacity of the liver facilitates the restoration of normal functioning of the liver following surgery.

Indications

It is done to chosen patients with:

• Hepatocellular carcinoma 
• Colon metastasis to the liver.
• Cholangiocarcinoma 
• Large benign hepatic tumors 
• Living donor liver transplantation 

Patient Selection Criteria

Not every patient is appropriate. Ideal candidates have:

• Right lobe local tumor.
• Sufficient liver remnant (FLR) in the future.
• Strong hepatic functional state (Child–Pugh A)
• No major vascular invasion
• Few adhesions or previous upper abdomen operations.

Preoperative Workup

• Compare to liver volumetry Contrast CT / MRI.
• Liver function tests
• Coagulation profile
• Cardiopulmonary evaluation
• Portal vein embolization (FLR is marginal)

Surgical Procedure

• General anaesthesia
• Laparoscopic ports (4-6 small ports).
• Liver mobilization and ligation of the ligaments.

Determination and management of:

• Right hepatic artery
• Right portal vein
• Right hepatic duct
• Transection parenchyma with ultrasonic or energy.
• Excision of the right lobe through a cushion incision.
• Check of bile leaks, placement of drains.
• Closure of ports
• Duration: 4–7 hours

Benefits Over Open Surgery

• Smaller incisions
• Less blood loss
• Reduced postoperative pain
• Faster recovery
• Shorter hospital stay
• Better cosmetic outcome
• Lower wound infection rates

Recovery & Hospital Stay

• ICU stay: Usually 24 hours
• Hospital stay: 5–7 days
• Oral diet: Within 1–2 days
• Go back to normal life: 3-4 weeks.
• Full recovery: 6–8 weeks

Right hepatectomy procedure

A right lobectomy is considered a major hepatectomy, and in addition to the right segment of the liver (V,VI, VII and VIII) the right lobe is comprised of the gallbladder fossa is included. The following brief narrative is employed in a process-like format to guide either patient information or document generation from the provider's perspective.

Preparation before Surgery

• General anaesthesia is used. 
• Patient lying in the supine position (occasionally with slightly opposite Trendelenburg).
• Antibiotic prophylaxis and DVT ordered.
• Central venous and arterial monitoring developed.

Surgical Access

• Open operation: Right subcostal (Mercedes-Benz) incision.
• Laparoscopic technique: 4-6 under-vision trocar ports

Liver Exploration

• Whole liver and abdominal cavity palpated.
• Ultrasound to determine the location and probability of the tumor during operation.
• Occult lesion or vascular assessment.

Liver Mobilization

Division of:

• Right triangular ligament
• Right coronary ligament
• Liver was mobilized off the diaphragm.
• Inferior vena cava (IVC) well exposed.

A test of hilar Dissection (Vascular Control)

At the porta hepatis:

• Right hepatic artery found, cut and separated.
• Isolated and divided isolated right portal vein branch.
• Right hepatic duct diagnosed and separated.
• Structures on the left side maintained.

Parenchymal Transection

• Demarcation line comes after control of vessels.

To divide liver tissue along the following plane using:

• CUSA (ultrasonic dissector)
• Harmonic scalpel
• Bipolar energy devices
• Clipped bile ducts and small vessels.

Hepatic Vein Division

• Right hepatic vein dissected and divided nearly at the IVC.
• Safe stapling or suturing done in order to avoid bleeding.

Specimen Removal

• Liver right liver lobotomy.
• Referred to histopathology.
• Margins affirmed presence of cancer surgery.

Hemostasis & Bile Leak Test

• Bleeding points controlled
• Leak test of bile done with saline or dye.
• Selective use of surgical drains.

Closure

• Layers of abdominal wall are closed.
• Closure of port sites (laparoscopic cases)
• Duration: 4-8 hours 

Care after Surgery

• ICU monitoring for 24–48 hours
• Monitoring liver function tests daily.
• Premature mobilization and pulmonary exercises.
• Gradual diet advancement

Right hepatectomy recovery

The process of recovery following a right hepatectomy (removal of the right lobe of the liver) is slow and relies on the health of the liver, the mode of surgery (open versus laparoscopic) and the fitness of the patient. The following is a clear patient friendly recovery guide.

Day 0 -2 Immediate Post-operative Phase

• Period in ICU: 24-48 hours of close observation.

Continuous monitoring of:

• Blood pressure, urine output
• Liver function tests
• Bleeding and drain output
• Controlled pain by epidural analgesia or IV analgesia.
• Pulmonary exercises to avoid complications of the lungs.

Early Hospital Recovery (Day 3–7)

• Migration out of ICU to common ward.
• Progressive intake of oral fluids and soft food.
• Drains are typically removed when the output decreases.
• Walking, sitting, early mobilization promoted.
• The liver starts to normalize its functioning.

Hospital stay

• Laparoscopic: 5–7 days
• Open surgery: 7–14 days

Home Recovery Phase (Weeks 2–6)

• Mild fatigue, abdominal pain is typical.
• Resume activities that are light daily in 2-3 weeks.
• Limit heavy lifting (>5 kg) during at least 6 weeks.
• Balanced diet with a lot of protein prescribed.
• Sufficient hydration to facilitate liver regeneration.

Liver Regeneration

• In a matter of days, liver starts rejuvenating.
• Considerable regeneration in 2-3 weeks.
• Functional recovery within 6-8 weeks.
• Normal liver size within 2 - 3 months.

Follow-up & Monitoring

• Regular blood tests 
• Imaging (ultrasound/CT) as required.
• Wound and drain site assessment.
• Cancer follow-up when the surgery had been done.

Return to Normal Life

• Office work: 3–4 weeks
• Driving: 3 weeks (providing it is pain-free)
• Complete physical activity: 6–8 weeks.
• Complete recovery: 2–3 months

Best hospital for right hepatectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Right hepatectomy is a large, but well-developed surgery on the liver done to treat benign and malignant liver cases. It has made the operation safer and more successful than ever, with careful patient selection, elaborate preoperative planning and developments in surgical techniques, particularly laparoscopic surgery. This is because most patients recover almost normal liver function within weeks due to the liver having a unique regenerative capability. Effective results are reliant on having mature hepatobiliary teams, careful postoperative attention and patient compliance to recovery regimes and hence right hepatectomy is an outcome and life-saving surgical procedure when well-indicated.

Right hepatectomy surgery India GetWellGo

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FAQ

1. Is right hepatectomy considered major surgery?

• Yes. It’s a major surgery to the abdomen, but it has high-let-down rates and an acceptable risk when practiced at appropriate-level hepatobiliary centers.

2. Can a person live normal after right hepatectomy?

• Yes. The liver regenerates, and most patients are back to their normal lives within a few months.

3. Is laparoscopic right hepatectomy superior to open resection?

• Laparoscopic surgery can provide less pain, faster recovery, and smaller incisions than open surgery for select patients, without any difference in long-term outcomes.

4. How much liver do you lose in right hepatectomy?

• 60 to 70% of liver is resected.

5. How long does liver regeneration take?

• Early regeneration occurs within days and is typically completed by 6-8 weeks, with near-normal volume by 2-3 months