Liver Surgery Course

Lesson 1 • Applied Imaging Anatomy

Correlates cross-sectional imaging with operative anatomy. Trains surgeons to translate CT and MRI findings into intraoperative spatial orientation.

Lesson 2 • Gross Anatomy of the Liver

Covers liver morphology, lobar divisions, and surface landmarks. Establishes the anatomical baseline required for all subsequent surgical orientation.

Lesson 3 • Biliary Anatomy and Variants

Maps intrahepatic and extrahepatic bile duct anatomy. Recognizing ductal variants prevents inadvertent biliary injury during resection.

Lesson 4 • Hepatic Vascular Architecture

Details portal venous, hepatic arterial, and hepatic venous systems. Understanding vascular territories is critical for bloodless resection planning.

Lesson 1 • Hepatic Reserve and Resectability

Defines future liver remnant concepts and safe resection thresholds. Links functional reserve data to operative planning decisions.

Lesson 2 • Liver Function Assessment Tests

Covers biochemical markers, synthetic function tests, and dynamic tests. Accurate preoperative assessment determines candidacy for major hepatectomy.

Lesson 3 • Cirrhosis and Fibrosis Impact

Examines how fibrosis and portal hypertension alter surgical risk. Guides patient selection and modification of operative strategy in diseased livers.

Lesson 1 • Multidisciplinary Team Decision-Making

Structures the tumor board process for hepatic surgical cases. Integrates oncology, radiology, and hepatology input into a unified operative plan.

Lesson 2 • Cardiopulmonary Risk Assessment

Evaluates cardiac and pulmonary fitness for major abdominal surgery. Identifies patients requiring optimization before proceeding to the operating room.

Lesson 3 • Radiologic Staging and Planning

Covers multimodality imaging protocols for staging and resection planning. Accurate staging prevents futile surgery and guides margin strategy.

Lesson 4 • Indications for Liver Resection

Defines oncologic and benign indications for hepatectomy. Establishes the clinical rationale that drives all subsequent evaluation steps.

Lesson 1 • Incision Selection and Exposure

Compares subcostal, midline, and Mercedes incisions for open hepatectomy. Incision choice directly affects exposure quality and wound morbidity.

Lesson 2 • Patient Positioning and Preparation

Covers supine and modified positioning for open and minimally invasive approaches. Correct positioning prevents nerve injury and optimizes hepatic exposure.

Lesson 3 • Hepatic Mobilization Techniques

Details division of hepatic ligaments and mobilization of the liver. Complete mobilization is prerequisite to safe parenchymal transection.

Lesson 4 • Intraoperative Ultrasound Use

Teaches real-time ultrasound for lesion localization and vascular mapping. Intraoperative ultrasound alters surgical plans in a significant proportion of cases.

Lesson 1 • Selective Hepatic Vascular Exclusion

Teaches selective inflow occlusion and total hepatic vascular exclusion. Selective techniques preserve hemodynamic stability while controlling bleeding.

Lesson 2 • Hepatic Vein Control

Details dissection and control of major hepatic veins. Safe hepatic vein management prevents catastrophic hemorrhage and air embolism.

Lesson 3 • Pringle Maneuver and Variations

Covers hepatoduodenal ligament occlusion techniques and ischemic tolerance. The Pringle maneuver is the cornerstone of intraoperative hemorrhage control.

Lesson 1 • Cut Surface Management

Addresses hemostasis, bile leak prevention, and drain placement on the raw surface. Proper cut surface management is the primary determinant of postoperative bile leak rate.

Lesson 2 • Anatomic Resection Principles

Defines anatomic versus non-anatomic resection and oncologic rationale. Anatomic resection along portal territories reduces local recurrence in hepatocellular carcinoma.

Lesson 3 • Ultrasonic Dissection Devices

Teaches use of ultrasonic aspirators and harmonic scalpels for transection. Ultrasonic devices reduce blood loss and improve visualization of vascular structures.

Lesson 4 • Stapling and Energy-Based Devices

Covers vascular staplers and bipolar vessel-sealing systems. Staplers accelerate transection of thick parenchyma and major vascular pedicles.

Lesson 1 • Repeat Hepatectomy Considerations

Addresses technical challenges of reoperation in a previously resected liver. Adhesiolysis, altered anatomy, and reduced reserve require modified operative strategies.

Lesson 2 • Left Hepatectomy

Covers left lobe resection with attention to middle hepatic vein preservation. Left hepatectomy requires careful management of the umbilical fissure structures.

Lesson 3 • Extended Hepatectomies

Teaches right and left trisectionectomy with segment 1 inclusion when indicated. Extended resections demand meticulous remnant vascular reconstruction planning.

Lesson 4 • Segmentectomy and Bisegmentectomy

Defines anatomic single and double segment resections for focal lesions. Segmentectomy preserves maximal functional parenchyma while achieving oncologic margins.

Lesson 1 • Enhanced Recovery After Liver Surgery

Covers multimodal ERAS protocols specific to hepatic resection. ERAS implementation reduces hospital stay and opioid use without increasing complications.

Lesson 2 • Bile Leak Diagnosis and Management

Covers ISGLS bile leak classification and treatment algorithms. Timely recognition and drainage prevent bile leak progression to biloma or sepsis.

Lesson 3 • Post-Hepatectomy Liver Failure

Defines PHLF grading, risk factors, and management strategies. PHLF is the leading cause of mortality after major hepatic resection.

Lesson 4 • Hemorrhagic and Vascular Complications

Addresses postoperative hemorrhage, hepatic artery thrombosis, and portal vein thrombosis. Vascular complications require rapid diagnosis and multidisciplinary intervention.