In the surgery participated: dr. Wacław Hołówko and dr. Jan Stypułkowski. The patient was anesthetized by dr. Marta Dec with the assistance of the nurse Ewa Królicka. Marzena Kaczmarska, MA, and Agnieszka Szwonder were the operating-theater attendants.
“The indication for surgery in a 72-year-old woman were two liver metastasis from the breast cancer. The location of the first neoplastic lesion in segment II/III allowed laparoscopic resection of part of segment III and segment II of the liver (Fig.1). The location of the second lesion in the posterior part of segment VII, high under the diaphragm, precluded laparoscopic approach. In this situation, the only and least invasive method of removing this tumor was liver resection through the right pleural cavity and through the diaphragm. In the first stage, the laparoscopic part of the operation was performed and then, after repositioning the patient, the thoracoscopic stage was performed. The surgery lasted 240 minutes. The post-operative course was uncomplicated and the patient left the Clinic, in a very good condition, on the fourth day after the surgery," says Professor Tadeusz Wróblewski.
The liver resection, performed for the first time in Poland, via thoracoscopic transdiaphragmatic approach opens new perspectives for minimally invasive treatment of patients in whom the location of the tumor in the part of the liver - under the diaphragm - makes laparoscopic approach impossible. Until now, the only alternative for these patients has been open surgery.
This surgery is another success of the Department’s team, which in a short period of time performed two pioneering laparoscopic multi-organ surgeries: resection of liver segments II and III with left hemicolectomy and cholecystectomy, and resection of segments V and IVb with right hemicolectomy and cholecystectomy. By performing these operations laparoscopically, and the last one together with thoracoscopy, cancer patients were able to start further treatment earlier and in good condition.
Fig.1 Location of both liver metastatic lesions (green color) in 3D liver reconstructions. (3D reconstructions made by the courtesy of Jan Witowski, MD, PhD)
Phot. View of the lesion located sub-diaphragmatically in the liver, from the side of the surgeon operating through the chest.
