Physician stories: The gentlest cut

If you were to visit surgeon Paul Hansen, M.D., with a golf-ball-sized tumor in your liver, you could expect to be presented with two options for getting rid of it. There’s the hard way, and then there’s the easy way. Luckily for you, Providence is one of a handful of centers in the nation to offer the easy way.

The hard way can only be described as a “maximally invasive” procedure, in which the surgical team holds open a 6- to 15-inch incision – running from the breastbone down to the belly button and then all the way over to your right side – for four to six hours while the surgeon carefully cuts out the tumor by hand. You’ll spend a week in the hospital, it will take months to recover, and much of the time you will be in a lot of pain.

The easy way is to have the whole procedure done laparoscopically through three to five keyhole incisions in the abdomen. If the tumor is very small, it can be zapped away with electrical energy through just two laparoscopic incisions (a technique called radiofrequency ablation). Either way, you’ll go home the next day, feel completely back to normal in about a week, and you may never need the prescription for pain medication that they will hand you on your way out the door.

Oh, and by the way, the laparoscopic procedure will decrease your chance of dying from surgical complications – by at least twofold. Like almost everyone who hears about the difference between open and laparoscopic surgery while visiting the Hepatobiliary and Pancreatic Surgery Program on the Providence Portland Medical Center campus, patient Anwar Ayoub, M.D., chose the laparoscopic surgery.

A 57-year-old general practitioner from Castle Rock, Wash., Dr. Ayoub was diagnosed during a routine screening with advanced colorectal cancer that had spread to his lymph nodes and liver. His doctor ordered six weeks of radiation and chemotherapy. After he recovered from that first round of treatment, the patient consulted Dr. Hansen on the best way to remove a 3-centimeter tumor in his liver. It didn’t take Dr. Ayoub long to decide to schedule his laparoscopic surgery for 2:30 p.m. one Friday at Providence Cancer Center.

The morning following his surgery, Dr. Ayoub was back at home recuperating and feeling positive. The four, half-inch incisions in his abdomen were already healing. Within 10 days, he was “feeling fantastic,” back to coaching children’s soccer (“the best team in the league”), and ready to resume his daily exercise routine – a brisk three-and-a-half-mile morning walk that takes in pristine views of the Cowlitz River and nearby Mount St. Helens.

With success stories like this, you would think that laparoscopic liver surgeries would be the norm. But in fact, Dr. Hansen and his colleagues are among just a handful of surgeons in the United States who routinely perform these laparoscopic procedures. They also are the busiest practice in minimally invasive liver and pancreatic surgery on the West Coast.

Any liver operation is a high-risk procedure, requiring so much skill and experience on the part of the surgeon that only a small fraction of patients with liver tumors are offered surgery as an option.

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