Resecting a Liver
The patient is brought to the operating theater and placed supine on the table. General endotracheal anesthesia has been induced.
You will take a deep breath, make a wish, or say a small prayer over the patient’s abdomen, which has been prepped and draped in the usual sterile fashion.
I used to ride with my father to the gas station on Sunday afternoons. I was in charge of wiping down the windshield with the sponge and squeegee stick.
My father drove fast and tapped the breaks in time to the music on the radio. Tapping harder and harder as I squealed for him to stop. On the way home, we would gobble down our candy bars. Snickers for me. Milky Way for him.
You will need to start by making an inverse chevron incision with an upper midline extension.
A thorough visual exploration is necessary, so it will be important to properly place the Thompson Retractor for excellent upper abdominal retraction.
My father and I had a paper route. We woke in the wee hours of the morning and sat shoulder to shoulder on the steps leading to the garage. Each newspaper had to be rolled and fastened with a rubber band or, if it was rainy, stuffed in a plastic bag. The smell of fresh print filled our heads, and the ink stained our fingers. He would drive the station wagon, trunk full of papers. I would walk along beside and pitch them onto porches. At dinner, we laughed about how sleepy we had been at school and work that day. Falling asleep in the pew at church, taking a nap in the break room.
At this time, a thorough visual exploration should begin. Palpate, lift, and massage the liver. Identify the area to be removed.
My father took me out to dinner the night my mother announced she was leaving us. I crammed fry after salty fry into my mouth, wiping my greasy fingers on my pant legs. He tried to console but I had already learned to stuff down my feelings. When the fries were gone, we both burst into tears.
It’s time to dissect the porta hepatis. You must identify the main hepatic artery and follow it until you find the bifurcation. Dissect it and tie a loop around it.
After my father moved out, Saturday mornings were our scheduled visitation days. He either took me to Friendly’s or Perkins and let me order a cheeseburger for breakfast. My father had his own place then, but I never visited there. Instead, we went to my grandparents’ house and watched TV on their couch. Drinking Pepsi and eating pickles right out of the jar.
Now you must remove the gallbladder in a top-down fashion. The gallbladder isn’t really necessary anyway. Once removed, double ligate the cystic duct.
My father drove me back to college after my boyfriend’s funeral. He let me lay my head in his lap even though I was too old for that. He didn’t speak of my sadness, he simply stroked my hair for the entire ride back.
One time, my father sent a huge box to my college dorm. Friends gathered to see what goodies were in this massive care package. Each box led to a smaller one nestled inside. The final, smallest box contained one milk bone dog biscuit and a note that said, “Go Browns, from the dawg pound!!”
You will be pleased with how the cut of the liver looks. You should inspect the inferior vena cava and be sure it was not impinged upon. There should be a good flow to it.
My father lost his eye to a brain tumor at sixteen years old. His glass eye was a source of endless fascination. If I begged long enough, he would agree to display it in the palm of his hand. His full name was typed on a small bit of paper, which was embedded in the back of the eye. When I was small and woke from bad dreams in the middle of the night, I’d run to his bed. His glass eye was always open. He swore it was because he was always looking out for me.
After achieving hemostasis, you will place a Jackson-Pratt drain in through a separate stab incision and lay this on top of the transected liver margin.
Now you will irrigate the abdomen and prepare to close it up.
My father’s visits are fewer and far between. Standing at my doorstep, tears streaming down his cheeks.
“I miss you already,” he says.
The upper midline extension will be closed using multiple figure-eight stitches. The inverse chevron incision is closed in two layers. The bottom using a deep running loop. The top stitched with more figure eights.
Now we visit daily through video calls. My father’s shrunken frame hunched over in his wheelchair, a warm blanket covering his legs. Sometimes it is enough to simply sit and smile at one another. The weight of the years too heavy to hold on the tip of the tongue.
“Love you, Dad.”
“Love you more.”
“Talk to you tomorrow.”
The liver resection is complete. Your patient is wheeled out on a gurney to the post-anesthesia care unit. He opens his eyes and says, “Is she here?” You answer, “She’s been here the whole time.”
My father’s days are coming to an end. We spend the remainder of them holding hands and softly singing songs of his youth. “Sink the Bismark,” “Hello Marylou,” and “Melody of Love.” I tell him how much I love him, and he whispers, “The feeling is mutual.”
Despite liver resection, your patient will have a 50 to 80 percent chance of cancer recurrence. Survival rates remain low.
Jennifer Pinto earned her doctorate in psychology from Wright State University’s School of Professional Psychology. She worked for many years as a clinical psychologist. Her work has appeared in The Sun Magazine, Her View from Home, and The Wonder Years. She lives in Cincinnati Ohio.