Laparoscopic Liver Transplant: Surgery, Recovery, Risks, Result

Did you know liver failures are responsible for 2 million deaths across the globe? Blame it on unhealthy lifestyles or scathing eating habits; today, liver diseases have become quite common, irrespective of age group. People who suffer from liver disease have a lot of difficulty with their digestion, turning food into usable energy. 

When the condition worsens beyond the reach of a medicinal cure, liver surgery is the last resort to save the diseased liver. With a 90% success rate compared to other liver surgeries, Laparoscopic Liver Surgery is the most popular and viable option for all liver patients. 

Procedure Name	Laparoscopic Liver Transplant
Alternative Name	Laparoscopic portoenterostomy
Conditions Treated	Liver Failure
Benefits of the Surgery	Shorter recovery time, Less pain and discomfort, Fewer complications, Cosmetic advantages, Minimally Invasive
Treated by	Hepatologist and Gastrointestinal Surgeon

Laparoscopic Liver Surgery is a minimally invasive surgical procedure in which the diseased liver is removed from the patient’s body and replaced with a healthy donor’s liver tissue through grafting. However, not all patients are eligible for this procedure. The patient has to go through a series of diagnostic tests before being eligible for the surgery. 

Laparoscopic liver surgery is ideal for people suffering from liver disease and liver failure. However, not all locations of liver tumours are suitable for a laparoscopic approach. You should opt for laparoscopic liver surgery if:

1. Your tumour is located close to the surface, requiring limited resection.
2. The tumour is located in the left lateral segments or anterior and posterior liver segments, not requiring the right liver to be mobilised.

Laparoscopy is not recommended for the tumours located in the posterior and superior liver segments as it requires full mobilisation of the liver.  The laparoscopic approach in liver surgery provides patients with smaller incisions, resulting in faster recovery and better cosmetic results. Furthermore, there are two main applications of laparoscopy in HPB (hepato-pancreatico-biliary) surgery - an accurate staging of the disease and resection. There are other reasons for going for transplantation like recurrent Viral Hepatitis, Biliary Atresia, Acute Hepatic Necrosis, etc. 

Following are the steps followed to complete the transplantation process:

1. Complete Inspection of Donor: The donor’s liver is inspected before being transplanted into another person. Doctors check to see any signs of damage before transplanting the organ into a new body. They also look for signs of hepatitis, HIV, or other infections. 
2. Thorough Inspection of Patient: The recipient is also thoroughly examined to ensure that he or she is healthy enough to receive the organ. This includes taking blood samples for testing and ensuring that the patient has no signs of infection.
3. Incision In The Abdomen: The surgeon makes a small incision in the abdomen that is only a little bigger than the diameter of an orange segment. It requires general anaesthesia, which is used to put the patient into a deep state of unconsciousness. 
4. Laparoscope Insertion: The liver surgery is done laparoscopically by inserting a camera / small telescope called a laparoscope through the small incision in the abdomen that fetches live view images onto a monitor to support the procedure. This allows surgeons to have greater control over their movements and visualise tissues. 
5. Removal And Transplantation: The surgeon then uses gas to inflate the stomach and pushes on it from inside to force the liver out of its normal location near the stomach. Then, with the help of medical instruments, he cuts off the diseased part of the liver, implants the donor’s liver tissue, and connects it with blood vessels.
6. Checking For Damage And Rejection: Once the liver is recovered from the donor and placed into the patient, it is examined and checked to ensure no signs of damage or rejection. It also undergoes biochemical tests to ensure that it’s healthy and ready to be used. 

The complete procedure takes about 3 to 4 hours, and due to its minimally invasive procedure, patients can experience quicker post-transplant recovery and lesser pain and scars. 

Before the laparoscopic liver surgery

1. You will be given general anaesthesia. A tube is then inserted through your mouth and into the stomach to keep you from choking on vomit.
2. It is important to discuss the entire process beforehand with the surgeon to prepare your mind and body for the surgery. 
3. A full-body check-up is also required to identify any underlying condition that may cause complications during the surgery.
4. You are advised to stop taking aspirin, ibuprofen, and other over-the-counter painkillers a day before the surgery. You should take Non-steroidal anti-inflammatory drugs (NSAIDs) with food until the day of surgery.
5. You need to avoid alcohol for at least 24 hours before the surgery as it could interfere with blood clotting and anaesthesia.

What Can You Expect On The Day Of Surgery?

1. On the day of the surgery, you will be asked to report to the hospital at least 3 hours before the procedure is scheduled.
2. You should not eat anything for about 6 hours before the surgery. You can drink plenty of water and take medications like aspirin as needed.
3. The team will escort you to your room, where you’ll undergo some routine tests.
4. A staff nurse or anaesthesiologist will check your blood pressure, pulse, and oxygen levels before the operation.
5. In the next step, you will be taken to a special operating theatre and placed on a table covered with warm blankets. 
6. A surgical team will make all the necessary incisions, replace the bad liver with healthy tissues to complete the process.
7. After the surgery, the staff will move you to a recovery room where nurses will help you recover from the anaesthesia, which may take about two hours.
8. Nurses who have prepared a written record of your medical history may also check on your blood pressure after an hour or two of rest.

1. The minimally invasive method makes the entire recovery process easy and quick. The surgery is usually completed in one hour, and you may go home the same day of the operation.
2. An intravenous (IV) drip will ensure that you get enough fluids, blood, and antibiotics in your body during your recovery period.
3. The first major sign of recovery is hunger: a full stomach is important for good digestion after surgery as well as to recover from anaesthesia.
4. It’s normal to experience some bleeding from your incisions. This may itch, sting, or be a little warm and red at first but will fade over the next few days.
5. You may experience mild nausea at first. This is normal and should only last for a day or two or less. 
6. You need to rest for several days after the surgery, and it is recommended not to lift heavy objects or engage in strenuous activities such as weight lifting for at least a month.
7. Infection prevention measures need to be strictly followed so that your body can quickly recover from any potential complications.

First Follow-Up Appointment After Your surgery

1. The first follow-up appointment after a laparoscopic liver surgery is typically done in the hospital.
2. This appointment will take place three to four weeks after surgery for most people.
3. It is important to schedule regular check-up appointments as you are exposed to other chronic ailments after the surgery, including high blood pressure, weight gain, diabetes, etc.

Being a prevalent procedure, there is an abundance and distinguished benefits of Laparoscopic liver surgery that proclaim its process:

1. The shorter recovery time means early mobility and hence, patients can return to their normal activities much more quickly than before.
2. There is less pain and discomfort than traditional surgery due to a small incision. Therefore, there is no requirement for analgesic drug postoperation. 
3. There are fewer complications since the incisions are smaller and can be closed quicker. Moreover, smaller incisions result in smaller scars postoperatively. 
4. The cost difference between laparoscopic surgery and conventional liver surgery is minimal, however, Laparoscopy Technology has cosmetic advantages.
5. The risk of developing wound infection and incisional hernia after surgery decreases with laparoscopic surgery. 

There are some rarely occurring risks associated with a laparoscopic liver surgeries, which include: 

1. Bleeding
2. Nerve injury
3. Blood clots
4. Anaesthesia complications 
5. Pneumonia 
6. Infection