• Liver lobectomy involves surgical removal of a liver lobe. The term massive hepatectomy is used where two or more lobes are resected in one procedure.
• Partial lobectomy implies removal of part of the lobe, sometimes referred to as subtotal lobectomy.
• Liver biopsy involves obtaining one or more samples for laboratory analysis including histology, copper analysis, and microbiology. Biopsy may be single or multiple.

Uses

• Focal, surgically resectable lesions, eg focal neoplasia Liver: neoplasia, hepatic abscesses, cysts, traumatic lesions Liver: trauma, arteriovenous fistulae Congenital portosystemic shunt (CPSS).
• Hepatic surgical biopsy Biopsy: hepatic.

Advantages

• Direct visualization and palpation of the entire liver is possible.
• Biopsy or resection of clinically relevant areas in focal hepatic disease can be assured.
• If hemorrhage occurs at a biopsy site it can be readily managed.
• If neoplastic disease is present the abdomen can be examined and additional samples obtained if necessary for complete surgical staging.

Disadvantages

• Animals suffering from hepatic disease may be poor anesthetic and surgical risks.

• Intensive care facilities and staffing are required for major hepatic surgery.

Alternative techniques

• For obtaining diagnostic samples from diffuse (or large focal) hepatic disease:
  • Percutaneous core biopsy techniques using ultrasound guidance Biopsy: ultrasound-guided.
  • Fine needle aspiration biopsies Fine-needle aspirate.

Decision taking

Pre-operative assessment

• Pre-operative assessment of liver function and hemostasis is an important step in all hepatic surgery patients. Hepatic disease may profoundly affect the metabolism of anesthetic drugs and hemorrhage is a potential complication in surgery of the liver.
• Patients with compromised hepatic function may have low blood albumin levels Blood biochemistry: albumin. Levels below 2.0 g/dl can potentially affect wound healing, and plasma or whole blood transfusion Blood: transfusion should be considered.
• The clinical implications from increased coagulation times in patients with liver disease are incompletely understood and an increased tendency for hemorrhage has not been consistently demonstrated in dogs with naturally occurring liver disease. However, some hepatic surgry carries the potential for life threatening hemorrhage, eg central or right division lobectomy, massive hepatectomy so it is advisable to take the necessary precautions, eg blood type +/- cross match, check availability of blood products, if the patient is already significantly anemic, consider transfusing pre-operatively.
• Hypoglycemia Hypoglycemia, is uncommon in veterinary patients with liver disease although toy breeds such as Yorkshire terriers may be more prone to hypoglycemia.
• In patients with severe ascites, withdrawal of some of this fluid pre-operatively may help alleviate associated respiratory distress but should be done with caution.
• If hepatobiliary disease is present (particularly in cats) there is an increased propensity for enteric-origin bacteria within the hepatobiliary system; peri-operative intravenous antibiotics are advisable.