Advances in Liver Surgery at the Mass General Liver Center

Cristina R. Ferrone, MD, is the surgical director of the Liver Surgery Program in the Division of General Surgery at Massachusetts General Hospital and an associate professor of Surgery at Harvard Medical School. In this video, she discusses the collaboration and cohesion across multidisciplinary teams that has enabled her team to provide safer, more advanced surgical experiences to patients.

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Transcript

Our liver program is incredibly unique at Massachusetts General Hospital because we work so cohesively together. Not only do we meet twice a week to review all of our new patients as well as our existing patients to make sure that we're providing the best care possible with a personalized care plan, [but as a result,] it also allows for weekly interactions to discuss research efforts, clinical trials, and other aspects of how we can optimize the care for our patients.

So we're doing a lot of research for our liver resection patients, not only in how we can better prepare them for a liver operation [and] how we can optimize their diet before the liver resection, but also postoperatively and how we can best manage their pain and improve their recovery.

At Massachusetts General Hospital, we're incredibly fortunate to have a very large cohort of experienced physicians who have been focusing their career on managing patients with liver masses and liver problems as well as liver cancers. We have a multidisciplinary clinic that meets twice a week, and all new patients are reviewed by a combination of experienced physicians who are surgeons, medical oncologists, radiation oncologists, hepatologists, interventional radiologists and interventional gastroenterologists. This allows us to put together a very comprehensive treatment plan for every single patient.

We are very fortunate here at Massachusetts General Hospital to have a great group of liver surgeons who have been working on minimally invasive techniques to do large liver operations. We started off doing small liver operations, but now we've done over 300 in total—with many being larger resections. This allows the patients to have smaller incisions, recover quicker, have less pain and get to chemotherapy faster if they need additional chemotherapy after the operation.

With the new robotic technologies as well as the new laparoscopic technologies, we can definitely provide patients with a safer and less traumatic operation. Instead of having a large incision that oftentimes crosses down and over the abdominal cavity, which is quite morbid, we can now do this all minimally invasively by being able to help develop technology, which has image fusion properties so that we can see the blood vessels and the bile ducts within the liver because the liver is very different than many of the other operations where we can see the major blood vessels. The liver instead is a much denser, larger organ where the capsule looks very homogeneous, and it's really an understanding of the internal anatomy that better helps us provide the patients with a safe operation. This allows for decreased bleeding, as long as we know where the main branches of the portal vein and hepatic vein are, as well as the hepatic artery, as well as the major bile ducts, and this can really help patients in terms of us decreasing the morbidity and mortality of these operations by decreasing their complication rates.

I think the most important part of Massachusetts General Hospital is the cohesiveness of our liver program in terms of bringing all the disciplines together for each one of our patients. The patients can have confidence that we are all looking at all of their imaging and their chart so that we can fully understand what the best treatment paradigm is.

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