Liver resection

In the surgical treatment of hepatocellular carcinoma, anatomical segment or wedge resection is performed. Blood loss is limited to 300-500 ml with the Pringle manoeuvre. Resection margins are determined under intraoperative ultrasound guidance and surgical margin negativity is confirmed. In the 3.5-6 hour operation, 60-75% of the organ can be removed, provided that the remaining liver volume is more than 30%. The 5-year survival rate after R0 resection is 65-75%. In two-stage hepatectomy, the second stage is performed when the FLR reaches 35-40%. The most common complications are bile leakage (8%) and intra-abdominal abscess (6%). Hospital stay is 7-10 days, and full recovery takes 6-8 weeks.

Laparoscopic surgery

In laparoscopic liver surgery, a pneumoperiton is created with a CO₂ pressure of 12-14 mmHg and 4-5 trocars are used. Tissue dissection is performed with an ultrasonic scalpel, and parenchymal transection is done with CUSA or LigaSure. It is preferred especially for tumours smaller than 5 cm, in segments 2-3-4b and 5-6. Advantages over open surgery: hospital stay is reduced to 3-5 days, blood loss is 150-250 ml, and postoperative pain is reduced by 65%. The rate of conversion to open surgery is less than 8% in experienced centres. Patients are mobilised within 48 hours and return to daily activities within 4 weeks.

Robot surgery

The Da Vinci Xi system provides 7-axis movement and 3D imaging with EndoWrist technology. The vibration filtering feature allows precise dissection in challenging areas such as the hepatocaval dome and portal hilum. Blood loss is 200-300 ml, and the need for transfusion is less than 5%. The use of ICG Firefly technology has reduced bile complications by 75%. In experienced centres, the R0 resection rate is 96%, and the average operation time is 180-240 minutes. The 3-year disease-free survival is 72%. 90% of patients return to work within 3-4 weeks.