4^th International Conference on Hepatology April 27-28, 2017 Dubai, UAE

Biography:

M Aerts is currently working at the University Hospital in Brussels, UZ-Brussel. She is a staff member of the Gastroenterology/Hepatology Department since 2012.

Abstract:

Background: NAFLD is a multifactorial disease with an enormous increase in prevalence worldwide. It is known that patients with diabetes mellitus type 2 (DMT2) are at higher risk of developing NAFLD and are more likely to progress to more severe disease.
Methods: Patients with DMT2 presenting at the diabetes liver clinic were evaluated with abdominal ultrasound (US). If steatosis was present, they underwent a Fibroscan® or elastography (ARFI) and a blood test. Risk scores, (NAFLD fibrosis score and Antwerp NASH score) were calculated to estimate the presence of NASH and/or advanced fibrosis.
Results: 112 patients underwent US, of which 90 (55 male, 35 female) had steatosis (80%). Mean age was 57.2 yrs (range 40 - 78). All patients with steatosis on US underwent Fibroscan® (11) or elastography (75) or both (4). 22 patients (24%) had ≥F2 fibrosis (Fibroscan® > 7.2 kPa or elastography >1.32m/s). 7 patients (8%) had F4 fibrosis, (Fibroscan® >14.5 kPa, or ARFI>1.87. The NAFLD fibrosis score was calculated in 90 patients. In 19 patients (21%) the NAFLD fibrosis score was > 0.676, suggestive for ≥F3 fibrosis; only in 10 patients (11%) the score was < -1.455, excluding significant fibrosis. The remainder (68%) had an intermediate score. The Antwerp NASH score was calculated in 86 patients. In 31 patients (36%) the score was > 1.34,
suggestive for NASH; in 9 patients (10.5%) this score was < -1.34, excluding NASH.
Conclusions: Our results confirm that NAFLD is very common in DMT2 patients. Moreover, many patients are at risk for developing NASH and/or advanced fibrosis. These patients should be followed-up closely to detect complications early. Awareness of this progressive disease among diabetologists and hepatologists is vital to identify patients who need close followup and hopefully specific treatment in the near future.

Biography:

Reju George Thomas has completed his MTech in Nanotechnology from Amrita Institute of Nanosciences and Molecular Medicine (ACNSMM), India during 2010- 2012 and PhD from Chonnam National University (Feb 2016). Currently, he is doing Post-doctoral research under Prof. Yong Yeong Jeong developing theranostic nanoparticles and conducting pre-clinical testing at Clinical Vaccine R&D Centre of Chonnam National University Hwasun Hospital.

Abstract:

Bilirubin is hydrophobic in nature and glycol chitosan was covalently attached to this compound via a stable amide bond resulting in chitosan bilirubin (ChiBil). ChiBil is found to have ability to undergo a solubility switch from hydrophobic to hydrophilic in response to intrinsic ROS. Advanced liver fibrosis is a condition characterized by ROS stress and metabolical effects in hepatocytes. In our study, we use ChiBil as a ROS quenching, anti-inflammatory agent which also have ability to load hydrophobic or hydrophilic drug against progression of fibrosis. Therefore, we have loaded losartan, a hyperthensive drug which is proven to have anti-fibrosis effect also, inside ChiBil. We have developed liver fibrosis model in C3H/HeN mice by administering thioacetamide and ethanol. ChiBil-losartan was injected through intravenous route in 3 dosages for a period of 9 days. Finally, we analyzed hepatic histopathology and biochemical estimation, respectively. We observed a dosage dependent improvement of hepatic fibrosis and biochemical examination (AST/ALT ratio) in the ChiBil-losartan treated group. ChiBillosartan micelles might be useful in reduction of mice hepatic fibrosis model.

Biography:

Ahmed S Ibraheem has obtsined his PhD from Virginia Common Wealth University in 2004 and then moved to Sohag University Egypt. Later, he temporaryly started working at Hail University, KSA. The field of specialization for him is Immunology with special focus on Autoimmunity.

Abstract:

In this study, we planned to test toxic effects of cadmium, aluminum either alone or combined with each other on sensitive organs as kidney and liver. The cadmium alone decreased the animal’s body weight. Meanwhile, aluminum did not affect the changes in body weight of cadmium treated animals; adding the zinc significantly reduced the loss of body weight. Serum creatinine and urea were significantly lower in treated group than in control group. Cadmium and aluminum or combination of them resulted in a significant increase in serum GPT and GOT activity. Zinc did not prevent the changes caused by aluminum, however, the changes resulted by cadmium intoxication were almost healed or ameliorated by zinc. Treating with Zn alone resulted in drastic effects on kidney tissues more than either cadmium or aluminum. Treating with cadmium or aluminum resulted in infiltration of the liver parenchyma with lymphocytes, fibrosis, micro vesicular steatosis of the hepatocytes for both and appearance of many phagocytic cells, pyknotic cells and vacuolation for cadmium. Combined cadmium and aluminum treatment resulted in less damage than cadmium alone with exception of fatty degeneration. Unexpectedly, zinc induced acute cells exibited vacuolation and steatosis. Cadmium and aluminum combined together did not worsen the situation as expected but was less damaging than cadmium alone, which suggests a possible synergistic effect of combination. Meanwhile, zinc failed to protect kidney from aluminumintoxication, which strengthens the suggestion of two different pathways of cadmium and aluminum intoxication. This finding meant that cadmium is more hepatotoxic than aluminum.

Biography:

Abdel Rahman Abdulla Al Manasra, MD, has completed his graduation in 2005 from Jordan University of Science and Technology, Irbid, Jordan with Bachelor’s in Medicine and Surgery. Later, he obtained a higher specialization degree in General Surgery from same university after 5 years of residency training at King Abdullah University Hospital. In 2013, he graduated from the Medical University of South Carolina and became an American Society of Transplant Surgeons’(ASTS) Certified Abdominal Multi Organ Transplant Surgeon. This was followed by a one year of specialized fellowship training in pediatric abdominal transplant surgery. Since 2014, he has been working as a Consultant Abdominal Transplant and Hepatobiliary Surgeon at King Abdullah University Hospital, as well as an Assistant Professor of Surgery at Faculty of Medicine, Jordan University of Science and Technology.

Abstract:

Background & Aim: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in obese patients and the commonest cause of liver disease in western countries. Although liver biopsy is essential for diagnosis, ultrasound may predict its presence. We aim to evaluate sensitivity, specificity and predictive value of ultrasound in diagnosing NAFLD’s patterns among morbidly obese patients.
Methods: 45 morbidly obese patients submitted to sleeve gastrectomy were prospectively studied. They underwent true cut liver biopsy during the surgery. Classification of histological patterns was based on the NIH-sponsored NASH Clinical Research Network NAFLD Activity Score (NAS). Prior to surgery, patients had an assessment for fatty liver changes by ultrasound (5 grades). The findings from histology (being the gold standard test) and ultrasound (being the test in question) were compared.
Results: 71% of patients were females (32/45). The mean age was 35 (range: 17-58) and the mean BMI was 43 (range: 35-52). The prevalence of NAFLD histologically was 91.8%. 19/45 patients (39%) had non-alcoholic steatohepatitis (NASH) on histology. Ultrasound’s sensitivity, specificity and positive predictive value in diagnosing either NAFLD or NAS were 50%, 85% and 25%; respectively. While its sensitivity, specificity and positive predictive value in diagnosing NASH were 28%, 100% and 100%; respectively. There was significant correlation between ultrasound grades and each of steatosis histologic grades (P<0.001), NAS (score) (P<0.001) and the presence of NASH (P<0.001).
Conclusion: NAFLD has a very high prevalence among morbidly obese patients. Assessment by ultrasound showed an absolute positive predictive value (100%) for NASH. This supports its routine use as a low-cost, non-invasive diagnostic tool for this co-morbidity in morbidly obese patients. The frequently reported low sensitivity of ultrasound may be attributed to technical difficulties inherited by the body habitus of morbidly obese patients. Liver ultrasound may contribute to identify obese patient’s candidate for bariatric surgery.

Biography:

Mohammad Firoz Alam is working as an Assistant Professor (Toxicology) in the Department of Pharmacology and Toxicology, College of Pharmacy, Jaan University, Jazan since 2010. He has specialisation in Neurotoxicology. Presently, he is engaged in toxicity evaluation of drugs and chemicals on animal models (rat/mice) and its protection management by using phytomedicine or drug. He has more than 11 years of experience in teaching and research at different universities. He is experienced in planning, development and execution of high impact research. He has 5 approved projects from Jazan University. He has successfully finished two projects and three are under progress. He has published 21 articles in peer reviewed journals with ISI Thomson Reuter. He has supervised six Pharm D students in Scientific Research Deanship Student Projects, Jazan University, Jazan, KSA.

Abstract:

Mitochondria are well known for energy source in hepatocytes and play an important role in extensive oxidative metabolism and normal function of the liver. Another important role of mitochondria is it helps in signalling pathways that mediatehepatocyte injury, because impaired mitochondrial function  contribute to several chronic liver diseases such as alcohol induced liver diseases, non-alcoholic fatty liver diseases, viral hepatitis, cholestasis and Wilson’s diseases etc. Impairment of the electron transport chain or oxidative phosphorylation causes to decrease oxidative metabolism, decrease ATP synthesis, and also reduce hepatocyte tolerance towards free radical insults. Several drugs, toxins and herbs have been reported to cause liver injury and drugs itself account for 20-40% of all instances of rapid development of hepatic injury. Swiss Albino mice were divided into 5 groups; group 1 was control. Group 2 received CCl4 as (1.5 mg/kg) in oil i.p, twice a week for 15 days. Groups 3 and 4 were pretreated with zingerone 50 and 100 mg/kg b.wt respectively once daily for 15 days. Group 5 was treated with 100 mg zingerone only. The animals were sacrificed on day 16 and livers were taken out to isolate the mitochondria. Results indicated that the content of lipid peroxidation (LPO) was increased significantly and the content of glutathione and activities of antioxidant enzymes; glutathione peroxidase (GPx) glutathione reductase (GR), glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT) were decreased significantly in the liver mitochondria of CCl4 treated group as compared to the liver mitochondria of control group. This impairment of mitochondrial changes was protected significantly and dose dependently with the treatment of zingerone in Group 3 and Group 4. Thus the present study indicates that the zingerone which is a part of our daily diet may be used as the best therapeutic potential tool for the prevention of liver injury.

Biography:

Ahmed S Ibraheem has obtained his PhD from Virginia Common Wealth University in 2004 and then moved to Sohag University Egypt. Later, he temporarily started working at Hail University, KSA. The field of specialization for him is Immunology with special focus on Autoimmunity.

Abstract:

Chronic inflammatory liver diseases can be induced by viral infections, toxic-metabolic factors and/or autoimmune mechanisms. Inflammation or viral infection results in hepatocyte damage or cell lyses which cause DNA or other cell nuclear materials to be released by hepatocytes to serve as auto-antigens that participate in auto-immune hepatitis. Those released cellular materials will be exposed to the immune system before phagocytosis by Kupffer cells. In this study, injecting rats with extracted DNA combined with CFA resulted in hepatitis cellular symptoms. Plasma globulin was increased and liver function enzymes were higher in plasma and lower in liver tissues compared to CFA and control groups. The inflammation was indicated histologically bythe presence  of active Kupffer cells, it led to irregularly shaped hepatic lobule, pyknotic cells, vacuolated nucleus and infiltration of liver parenchyma with lymphocytes. Vacuolation of the cells with fatty degeneration and necrotic hepatocytes also, was recorded. It is clear that using cell nuclear materials can induce inflammation that has some hepatitis identity.

Biography:

Hossein Kargar Jahromi has a PhD in Comparative Histology. He is a member of Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran and Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.

Abstract:

Statement of the Problem: In addition to metabolism of different compounds, detoxification of drugs, environmental pollutants and, in general, of various toxins is one of the important functions of the liver (1). In most cases, during the detoxification process, metabolic activation by cytochrome P450 enzymes in liver microsomes causes production of toxic and active metabolites that can damage various tissues including the liver (2). Isoniazid also, despite its effectiveness in treating tuberculosis, causes acute complications for hepatic cells through the production of free radicals (3, 4). Hepatic toxicity caused by isoniazid can appear as cellular necrosis, steatosis (accumulation of fats), or both. Metabolites of this drug also have toxic effects on liver cells (5) Hydrazine is one of the most important metabolites of isoniazid. Plants have always been considered one of the main options for treating poisoned livers because they are available natural sources of antioxidants. orchid or Dactylorhiza lancibracteata (C. Koch) Renz, formerly named Orchis maculate L., belongs to the family Orchidaceae, has various species, and grows almost everywhere in the world. Its root nodules, which can usually be harvested in early summer, keep their medicinal properties for up to two years (6, 7). Therefore, considering the presence of antioxidant compounds in orchid, and given its protective effect against hepatic toxicity, this research was conducted to study the effects of aqueous extract of this plant against liver poisoning caused by isoniazid in rats.

Methodology & Theoretical Orientation: Rats were randomly place in the 7 eight-member groups of the control, the sham (receiving distilled water), the isoniazid group ( that was given this medicine at 50 mg/kg), and the experimental groups 1, 2, 3, and 4 that received isoniazid at 50 mg/kg together with 40, 80, 160, and 320 mg/kg of the extract. The rats were injected intraperitoneally for 28 days, SPSS was employed to analyze the data, and one-way ANOVA and Duncan’s test were used to compare the groups.
Findings: The groups treated with isoniazid and various doses of the extract significant reductions in serum levels of hepatic enzymes. Comparison of the various doses of the extract indicated the 320 mg/kg dose had the maximum therapeutic effect against hepatic injury caused by isoniazid.
Conclusion & Significance: Orchid extract, probably because of its antioxidant properties, could improve the destructive effects of isoniazid on the liver.

Biography:

Abdulaziz Shaher is a Board Certified General Surgeon and Intensive Care Fellow. He is an Associate Fellow of the American College of Surgeons, Active Member in the Saudi and the American Critical Care Societies with a specific interest in acute care surgery, resuscitation and trauma.

Abstract:

The high prevalence of gallstones within the Saudi Arabian population is the leading cause of Acute Pancreatitis (AP), the disease notorious for its range of severity and challenging management options. AP is a medical disease that is commonly managed by surgeons in most of the institutions within Saudi Arabia. AP is a wait and sees disease an area that is well mastered by the physicians, where the surgeons lack a huge deal of experience in this field, and indeed they feel incapacitated exactly as if you take the rifle from a sniper and you tell him to wait and see. Surgeons choose surgery because they are doers and physicians chose medicine because they are thinkers and nothing wrong with either choice, but things get missy when you through a medical ball such as AP in the field of surgeons, they suddenly want to kick it while in fact it’s an oracle crystal ball. At the same time Gastroenterologists maximum input would be to do and ERCP, while it can be difficult sometimes, but still a 1 hour challenge would melt in front of daily continuous care. Here comes the choreographer; the designer of the initial aggressive resuscitation, the follow up and the de-resuscitation phase to take back all the excess fluids that have been given. The aim of this presentation is to discuss in brief the resuscitation principles and endpoints of the Systemic Inflammatory disease as a result of AP and rule played by the Intensivist through the whole phases of challenging cases of AP. The integration of the echocardiographic target goals of resuscitation, the dry resuscitation principles, the abdominal compartment syndrome,vacuum management in open abdomen and the de-resusciation towards the recovery phase. In this article I’m trying to capture the whole aspect of the complicated pancreatitis management within the ICU setting, from the eye of a surgeon/Intensivist.

Biography:

Abdel Rahman Abdulla Al Manasra, MD, has completed his graduation in 2005 from Jordan University of Science and Technology, Irbid, Jordan with Bachelor’s in Medicine and Surgery. Later, he obtained a higher specialization degree in General Surgery from same university after 5 years of residency training at King Abdullah University Hospital. In 2013, he graduated from the Medical University of South Carolina and became an American Society of Transplant Surgeons’ (ASTS) Certified Abdominal Multi Organ Transplant Surgeon. This was followed by a one year of specialized fellowship training in pediatric abdominal transplant surgery. Since 2014, he has been working as a Consultant Abdominal Transplant and Hepatobiliary Surgeon at King Abdullah University Hospital, as well as an Assistant Professor of Surgery at Faculty of Medicine, Jordan University of Science and Technology.

Abstract:

Background & Aim: Obesity related non-alcoholic fatty liver disease (NAFLD) is increasingly recognized worldwide. Multiple predictive and risk factors have been proposed for NAFLD. We aim to describe the prevalence, histologic patterns, and risk factors for this disease in morbidly obese patients undergoing sleeve gastrectomy.
Methods: This is a prospective study, which included a cohort of 49 obese patients undergoing sleeve gastrectomy with concomitant true cut liver biopsy. Patients were excluded when they have history of alcohol intake, liver disease, or hepatotoxic agents’ intake. Clinical, biochemical, and histological features were evaluated. Histological patterns were classified based on the NIH-sponsored NASH Clinical Research Network NAFLD Activity Score (NAS).
Results: Most patients were females (73%), with mean age of 34 (range 17-58). Mean BMI was 43 (35-52). 45 patients (91.8%) showed NAFLD, 19 (39%) showed non-alcoholic steatohepatitis (NASH) and 5 (10%) showed fibrosis. Only 4 biopsies (8%) were reported as normal. Significant correlation was found between low-density lipoprotein (LDL) vs. NASH (P=0.005), LDL vs. steatosis grade (P=0.023), aspartate aminotransferase (AST) vs. NAS (P=0.005), AST vs. steatosis grade (P=0.009), glucose vs. steatosis (P=0.006), sex vs. NAFLD (P=0.02), and sex vs. hepatocyte ballooning (P=0.005). There was no morbidity or mortality in this study.
Conclusion: NAFLD has a very high prevalence among morbidly obese patients. Significant correlation is evident between biochemical markers and histological components of liver assessment. Intraoperative liver biopsy is safe in morbidly obese patients undergoing sleeve gastrectomy for the diagnosis of NAFLD.

Biography:

Rehan Saif is a Consultant in HPB Surgery and Abdominal Multi-Organ Transplantation. He is associated with the Integrated Liver Care Team at Aster DM Healthcare Group in India running multi-organ transplant centers at Aster Medcity, Kochi and Aster CMI Hospital, Bangalore. He completed his Post-graduate General Surgical training in India following which he spent 12 years gaining further specialist higher surgical training in the United Kingdom. He obtained his MRCS and FRCS (HPB and Transplantation) from The Royal College of Surgeons of Edinburgh leading on to CCT (UK). He also completed the European Diploma in Transplantation (European Society for Organ Transplantation) and is accredited by the UEMS (European Board of Surgery) where he obtained his FEBS (HPB Surgery). This was followed by a period of further fellowships and training in the field of Liver Transplantation first at the Institute of Transplantation, Newcastle upon Tyne, UK (Post CCT Senior Fellowship) and then an International Travelling Fellowship in Living Donor Liver Transplantation at the Kaohsiung Chang Gung Memorial Hospital, Taiwan (RCSEd Ethicon Travelling Fellowship). He is also trained in the Field of Robotic Minimally Invasive HPB Surgery in the UK, Europe and has done an International Fellowship in Robotic HPB Surgery at UIC Medical Center, Chicago (USA). He is an expert in highly advanced procedures including liver
transplantation (live donor and cadaveric), pancreas transplant, kidney transplant, complex HPB surgery and minimally invasive robotic HPB surgery.

Abstract:

Liver transplantation has become an established modality of treatment for patients with end stage liver disease. The shortage of deceased donor organs has led to living donor liver transplantation (LDLT) becoming a valid alternative in selected transplant centers, and its safety and feasibility have been well determined. Minimally invasive surgery mainly laparoscopic surgery has been adopted in various surgical fields over the last two decades with well validated advantages such as reduced blood loss, reduced postoperative morbidity, shorter hospital stay and excellent cosmetic outcome in comparison to conventional open surgery. However, despite inception over 15 years ago laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. The delay in the wide application of minimally invasive liver surgery can probably be explained by the requirement of extensive open liver resection experience, in-depth understanding of anatomy, and potential for massive bleeding, need for considerable laparoscopic technical expertise and a protracted learning curve. Given that a liver resection is ideally suited for a minimally invasive approach as there is no anastomosis and a very large incision is required in the open approach, there has been an increasing interest in this technique worldwide. However the actual experience is limited to a few selected centers and guidelines remain inadequate. Furthermore, the application of minimally invasive liver surgery to liver graft procurement in LDLT have been delayed significantly due to concerns about donor safety, graft outcome and the requirement of expertise both in laparoscopic liver surgery and LDLT. Some experienced centers now routinely employ laparoscopic left lateral segmentectomy as standard of care in adult-to-pediatric LDLT. There has been a recent shift in the application of minimally invasive approach towards the procurement of left lobe and right lobe grafts in adult-to-adult LDLT. However the number of cases is too small and restricted to very few centers. The use of newer technology such as the robotic platform offers certain distinct advantages over traditional laparoscopy such as a stable magnified field with 3-D vision and enhanced instrument articulation, enhanced ability for suture ligation and an additional fourth robotic arm. This facilitates and improves the possibility of minimally invasive liver resection even in challenging major liver resection such as liver graft procurement in LDLT. Minimally invasive live donor hepatectomy is technically feasible with outcomes comparable to conventional open surgery. However careful validation of larger sample sizes is necessary to achieve standardization and wider application. The most important concern remains donor safety.

Biography:

Sonal Asthana is a trained Hepatobiliary and Transplant Surgeon with work experience in leading centers in North America, UK and India. He has completed an American Society of Transplant Surgeons-Accredited Fellowship at the University of Alberta Hospital, Edmonton, Canada. The management of a transplant team requires a strong multidisciplinary approach to patient care, which is fairly different from the traditional hierarchical method still common in most surgical practice. Managing teams of highly skilled individuals working towards common goals will be a key skill for managers in modern medicine. He has authored more than 35 peer-reviewed papers, and has won international awards for basic and clinical research. His research has been supported by competitive grant funding from government and industry.

Abstract:

Background: Bio-engineered in vitro 3D human liver tissues, that are structurally and functionally accurate, provide an opportunity to reconstruct biological processes, both physiological and pathological. Normal cell physiology and function strongly depend on cell-cell and cell-extracellular matrix (ECM) interactions in the 3D tissue environment. Cells grown in 2D do not exhibit in vivo cell polarization and cellular interactions, and are generally non-viable after confluency within 3-5 days. The utility of co-culture of different cell types is limited by overgrowth of some cell types, especially fibroblasts using current two dimensional (2D) monolayer culture.
Methods: Hepatocytes and fibroblasts were encapsulated in an ECM-mimetic hydrogel, and 3D bio-printed as micro patterns with low aspect ratios. Typically 50,000 cells in 25 μl of hydrogel were extruded to about 5 mm in x and y directions, and 1 mm in the z direction. The hydrogel was then thermally cross linked to achieve the desired shape. These cell based tissue constructs were then cultured under standard conditions. Viability, histology, bio chemistry, gene and protein expression were observed at timely intervals.
Results: 3D bio-printed tissues express various critical liver functions such as production of albumin, cholesterol, fibrinogen, transferrin, urea, and inducible cytochrome P450 enzymatic activities (CYP1A2 and CYP3A4). Histology shows in vivo like cellular morphology. Viability and functionality of the 3D tissues could be maintained for 8 weeks, as compared to 5-7 days for conventional 2D cell culture. Hepatocytes and fibroblasts could be co-cultured in distinct hydrogel micro compartments, without fibroblast overgrowth and hepatocyte suppression. We present a novel 3D liver tissue platform that can be manufactured reproducibly, harbor multiple cell types in micro architectures, express functionality over an extended period of time, and thus can be used as a tool for translational medical research.

Biography:

Rehan Saif is a Consultant in HPB Surgery and Abdominal Multi-Organ Transplantation. He is associated with the Integrated Liver Care Team at Aster DM Healthcare Group in India running multi-organ transplant centers at Aster Medcity, Kochi and Aster CMI Hospital, Bangalore. He completed his Post-graduate general surgical training in India following which he spent 12 years gaining further specialist higher surgical training in the United Kingdom. He obtained his MRCS and FRCS (HPB and Transplantation) from The Royal College of Surgeons of Edinburgh leading on to CCT (UK). He also completed the European Diploma in Transplantation (European Society for Organ Transplantation) and is accredited by the UEMS (European Board of Surgery) where he obtained his FEBS (HPB Surgery). This was followed by a period of further fellowships and training in the field of Liver Transplantation first at the Institute of Transplantation, Newcastle upon Tyne, UK (Post CCT Senior Fellowship) and then an International Travelling Fellowship in Living Donor Liver Transplantation at the Kaohsiung Chang Gung Memorial Hospital, Taiwan (RCSEd Ethicon Travelling Fellowship). He is also trained in the field of Robotic Minimally Invasive HPB Surgery in the UK, Europe and has done an International Fellowship in Robotic HPB Surgery at UIC Medical Center, Chicago (USA). He is an expert in highly advanced procedures including liver transplantation (live donor and cadaveric), pancreas transplant,kidney transplant, complex HPB surgery and minimally invasive robotic HPB surgery.

Abstract:

Liver surgery has advanced more than any other type of surgery since the early 1980s. This is partly due to advances in technology and surgical instrumentation, as well as in anesthetic management of patients. In fact, indications for extended liver surgery interventions being performed today were thought of as unthinkable practice just a few decades ago. The open approach continues as the predominant one in liver surgery, despite great enthusiasm following the development and growth of laparoscopy since the early 1990s. In some high-volume centers with skilled surgeons, laparoscopy is now the method of choice when performing left lateral segmentectomy or when lesions are located in anterior segments. However, major resection (removal of three or more segments) is typically performed using the open approach. In our experience, the robot-assisted approach is distinctly different from laparoscopy for this type of surgery. Major liver resection using the robot is not only feasible but also advantageous, creating the ideal gateway for minimally invasive surgery of the liver of all liver resections, right hepatectomy is the most commonly performed worldwide, and its technique is well standardized. In this video, we describe the surgical steps of this technique using the robot-assisted approach. Robotic right hepatectomy is feasible, safe and offers a new
technical option for minimally invasive major liver resection.