Stanford Surgeons Perform Ex-Vivo Liver Surgery to Remove Tumor

Surgeons at Stanford Health Care recently conducted a novel ex-vivo liver surgery to remove a benign tumor from a patient. The procedure involved the complete removal of the liver from the patient, resection of the tumor outside the body, and subsequent re-implantation of the liver.

The decision to utilize the ex-vivo approach was based on the challenging location of the tumor within the liver, requiring meticulous vessel dissection.

“We chose ex-vivo because the tumor was located in a challenging area, necessitating the cutting of numerous vessels deep within the body,” said Kazunari Sasaki, MD, a clinical associate professor in Stanford’s Division of Abdominal Transplantation.

The tumor was diagnosed as focal nodular hyperplasia (FNH), a benign condition. Although large FNH tumors can often be observed without intervention, in this case, the decision to operate was based on two factors: first, the patient developed jaundice due to biliary duct compression caused by the tumor; second, her desire for future pregnancy, as this type of tumor can grow in response to hormonal changes during pregnancy.

“Although we might have been able to perform the surgery without utilizing the ex-vivo technique, it would have posed a high risk of significant bleeding due to the tumor's compression of multiple large vessels,” said Dr. Sasaki.

Despite increasing procedural complexity, this technique notably reduced operative time to six hours and eliminated the need for a blood transfusion, compared to conventional methods that typically last over eight hours with transfusions.

“While this technique demands a high level of skill, our surgical team is well-equipped to handle such challenges,” said Dr. Sasaki, who performed the operation alongside Brendan Visser, MD, a Professor in Stanford’s Division of General Surgery Hepatobiliary and Pancreatic (HPB) Surgery Section.

In ex-vivo surgery, the liver must be extracted with extreme care, as it will be re-implanted.

“This procedure leaves no room for even minor errors, requiring a high level of precision,” said Dr. Sasaki. “Both of us possess the necessary skills to perform this surgery independently, but by working together, we can further enhance the procedure's safety and success.”

Throughout the resection portion of the surgery, the patient's liver was maintained outside the body using preservation fluid and ice to ensure its viability.

“It's a weird experience to work out of the body in a truly bloodless field,” said Jon Harrison, the HPB Fellow who assisted Dr. Visser with the surgery. “The coolest part is once it goes back in the patient, it starts working right away.”

Indications for ex-vivo surgery remain quite limited. While ex-vivo surgery remains a specialized technique, recent surgical advancements have made it a viable alternative for patients with complex liver tumors.

“For patients who are told their tumor is ‘unresectable’ or ‘very difficult to resect safely,’ ex-vivo surgery may provide an alternative option for treatmen,” said Dr. Sasaki.

Individuals interested in exploring ex-vivo liver surgery are encouraged to seek consultation and undergo thorough evaluations at Stanford Health Care to determine their suitability for this innovative surgical approach.

Media Contact

About Stanford Surgery

The Stanford University Department of Surgery is dedicated to inventing the future of surgical care through:

• pioneering cutting-edge research, 
• developing the next generation of leaders, and 
• healing through incomparable surgical skills and compassion. 

To learn more, please visit surgery.stanford.edu