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Sedation (to reduce irritability and agitation of the subject during procedure) with analgesia (painkillers) and vital signs monitoring should be set up. Before the procedure, bedside ultrasound is done to confirm the position of the dilated bile ducts in the liver. The puncture site is then marked.
The surgery involves exposing the porta hepatis (the area of the liver from which bile should drain) by radical excision of all bile duct tissue up to the liver capsule and attaching a Roux-en-Y loop of jejunum to the exposed liver capsule above the bifurcation of the portal vein creating a portoenterostomy. [1]
Prior to surgery, cytotoxic agents such as oxaliplatin given systemically for colorectal metastasis, or chemoembolization for hepatocellular carcinoma can significantly decrease the size of the tumor bulk, allowing then for resections which would remove a segment or wedge portion of the liver only. These procedures can also be aided by ...
A TIPS procedure decreases the effective vascular resistance of the liver through the creation of an alternative pathway for portal venous circulation. By creating a shunt from the portal vein to the hepatic vein, this intervention allows portal blood an alternative avenue for draining into systemic circulation.
Abdominal ultrasound can be used to diagnose abnormalities in various internal organs, such as the kidneys, [1] liver, gallbladder, pancreas, spleen and abdominal aorta.If Doppler ultrasonography is added, the blood flow inside blood vessels can be evaluated as well (for example, to look for renal artery stenosis).
Percutaneous transhepatic cholangiography (PTC): Examination of liver and bile ducts by x-rays. This is accomplished by the insertion of a thin needle into the liver carrying a contrast medium to help to see blockage in liver and bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP). Although this is a form of imaging, it is both ...
Most image-guided surgical procedures are minimally invasive. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is interventional radiology. A hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area. [8]
Absence of the portal system in a first trimester case associated with hygroma and aorto-umbilical fistula. (A): Transverse plane of the upper abdomen with color Doppler applied, showing umbilical cord insertion, stomach, the prominent hepatic artery and no afferent liver venous perfusion; (B): midsagittal plane reconstructed from a three-dimensional volume acquisition were the crown-rump ...