Opening a New Horizon for Laparoscopic Liver Transplantation
Liver transplantation is the most effective treatment method to reduce the high recurrence rate of liver cancer. Recently, for the first time in the world, a pure- laparoscopic robot liver transplant surgery, which minimizes wounds and complications and shortens the recovery period, has attracted attention. I met with Professor Seo Kyung-seok of Seoul National University Hospital to talk about the factors and methods that made surgery possible, which was known to be impossible, and the complications and management after liver transplant surgery.
Q. Medieus Queen: Hello, I understand that you have more than 3,500 liver transplants in more than 30 years, including the first "divided liver transplant," "assisted liver transplant," "minimum liver transplant," "abdominal liver transplant," and "liver transplant from the person who died due to cardiac arrest" It's an honor to meet the professor, who is the head of Seoul National University Hospital's Hepancreatic Surgery Department and a world-renowned master of liver cancer surgery. Please introduce yourself, professor.
A. Seo Kyung-seok: Professor at Seoul National University Hospital (hereinafter referred to as Seo Kyung-seok) I majored in surgery and I have mainly performed liver surgery so far since I was assigned in 1993. I conduct a lot of hepatic surgery and liver transplantation for patients with liver cancer or other liver diseases. In my case, I am in the department of hepatic pancreatic surgery, particularly I majored in the field of liver care and focused only on liver-related surgery, which allowed me to come up with various ideas. Seeing the case of death because there was no other treatment before, I decided to save the patient's life by developing surgery. I thought I'd develop a surgical method that would make it easier to get surgery and minimize the aftereffects and scarring.
I planned a new surgical method, saw the possibility through animal experiments several times, and then went into surgery. Through these processes, I developed several new surgical methods and saved several lives through continuous development such as laparoscopic surgery.
Q. Medieus Queen: I understand that you have recently succeeded in a pure laparoscopic-robot recipient liver transplant for the first time in the world. Please explain the background of the surgery that was known to be impossible, the factors that could have been possible, and the differences in the surgical method and complications compared to conventional surgery.
A. Seo Kyung-seok: Originally, liver transplant surgery involves a very large wound to the stomach, and sometimes the wound swells up. In the case of donors, as they have a normal condition, they should not go wrong after surgery. The liver function recovers after surgery, but I felt sorry that I didn't play the role of a doctor properly if there was an irreversible scar left. So to reduce the wound, we started laparoscopic surgery with the donor. Recently, it is called pure laparoscopic surgery, and the liver is taken out by making an incision into the panty line about 10 to 12cm after performing laparoscopic surgery to some extent. So the prognosis is so good that some people can't find surgical marks.
In fact, liver transplantation using this laparoscope is a very difficult operation. There should be no bleeding, blood vessels or biliary tract should be completely separated, and resection should be done while maintaining well without causing any wounds. However, in our hospital, the operation through laparoscopy is standardized to use by almost 90% of the donors. We have done more than 100, 200, and 500 surgeries, and personally, I did about 400 surgeries, so I did it the most. In the meantime, through an accurate understanding of technology and know-how, especially anatomy, donor surgery has become more and more developed and standardized. So, even though it is difficult, it is applied to beneficiaries.
The donor's liver is usually in good condition, so there is no big problem with surgery. On the other hand, the beneficiary's liver is particularly tricky and more difficult for the operation than the donor's because it has a mild stool, and does not coagulate blood. And also, we should not touch the enlarged blood vessels called varicose veins. The surgical method is to remove the removed the through inside the panty line like a donor, and put the donor's liver back there through laparoscopic surgery. Or you have to anastomosis, and you can smooth the process of attaching blood vessels with a robot. In particular, it can be advantageous to use a robot because it connects 2 to 3mm of arteries. Through this method, the patient's recovery is faster and pain is reduced compared to conventional surgery. It's not completely standardized at the moment, and it's a surgical method that only our hospital is doing, but we need to develop it and gradually standardize it.
Q. Medieus Queen: Usually the donor is normal, but the recipients have diseases. Then the surgery will be very difficult. I don't think we can all do it just because patients want to have a laparoscopic liver transplant. Is there a case that's possible?
A. Seo Kyung-seok: I can't tell you exactly about that yet. First of all, if the liver is severely damaged, and there are too many ascites or varicose which make it difficult to secure enough blood vessels, it is hard to operate. Usually, there are cases where blood clots are full in the context of the connection or the hepatic vein. In this case, it is hard to operate because we have to dig it out. I think it can be partially performed in patients who have improved their function to some extent and do not have a lot of toxins. As the liver transplant itself is a life-saving operation, the priority is to save lives regardless of the wound. And there aren't many cases yet. For now, it is important to target only those who are in the proper condition for the operation. It will take more time in the future, but it will be possible for most patients when it develops gradually when experiences of donor laparoscopic liver transplantation are accumulated.
Q. Medieus Queen: I understand that liver transplantation rates are very low among all liver cancer patients. Why is it low?
A. Seo Kyung-seok: Liver transplantation is recognized as the best treatment for patients with liver cancer or terminal liver disease. You only have to do it with early cancer to get good results by liver transplantation. There are conditions that apply. If one tumor is less than 5cm, or if there are many, up to 3 tumors should be less than 3cm and there should be no metastasis to other organs. When these conditions are met, the survival rate is 75 to 80%. It is a very good grade, but if it exceeds the conditions, the recurrence rate may be high and the survival rate may decrease. So if you quickly detect liver cancer at an early stage, it is considered that liver cancer is to be treated by liver transplantation.
But there's also the issue of giving. In other countries, there are quite a few dead liver transplants. In Korea, the number of donors is very small compared to the number of patients, but dead liver transplants are generally not possible for patients with healthy liver cancer. Most liver cancer patients now have a biological liver transplant because the priority goes to those with worse liver in case of a lack of scores. It's legally defined, and it's regulated. So it needs to be detected early and needs a donor. Because of these two conditions, not everyone can still have a liver transplant. And I think it's better to remove it as a primary treatment if possible because the hepatic agent performance is still excellent in single-tumor cancer cell patients and liver transplantation can be considered after recurrence.
Q. Medieus Queen: I understand that after liver transplantation, biliary tract complications occur between 15% and 50% of transplant patients. What are the causes and treatments for these complications?
A. Seo Kyung-seok: One of the most worrisome things about transplanting people is that after they were discharged from the hospital because the surgery went well, they visit an outpatient clinic and find that there are some problems in liver function and the biliary tract stenosis may occur. The biliary tract is a structure in which bile flows, and it's very irritating, so if the bile flows into the abdominal cavity, the patient is very sick and it worsens and clogs the surrounding tissue. And in the case of beneficiaries, since they have previous diseases, the quality of the biliary tract itself and the distribution of blood vessels may be so bad that biliary tract stenosis is likely to occur. Therefore, biliary tract stenosis occurs due to these various causes, and some patients often continue to suffer from it. After repeated hospitalization, biliary tract inflammation occurs, and the fever goes up and down.
But it's getting a lot better recently. We have braces or these days, we use an endoscope to pierce them and keep them for a long time. In order to prevent biliary tract complications, surgery should be done well first. We are still studying how to insert bile drainage tubes to help blood flow well and prevent bile leakage.
Q. Medieus Queen: Many patients have difficulty managing infections and side effects from taking immunosuppressants after liver transplantation. What should I take care of or be careful of after liver transplantation? Also, I wonder if it is okay to get a COVID-19 vaccine while taking immunosuppressants.
A. Seo Kyung-seok: You still have to take immunosuppressants for life after transplantation. Of course, some people quit immunosuppressants, but they generally have to take them for life. Immunosuppressants have improved a lot, but they cause patients more vulnerable to infection than ordinary people because their immunity is suppressed. And there is a high possibility of cardiovascular disease due to the side effects of the drug itself. Blood pressure may rise, and lipids may deteriorate, causing diabetes. The incidence of cancer is also high, so it is important to prepare well and prevent it.
The most important thing is to follow the rules of life. You have to keep your weight well and exercise. Regular checkups are also important.
As for COVID-19 vaccination, the probability of antibodies being created is significantly lower than that of the general people due to immunosuppressants. In most cases, less than 50% of antibodies are created when inoculated up to the second shot. In some cases, they need to be vaccinated to rise to a certain level only after 3rd shot.
Q. Medieus Queen: Is there a way to keep your liver healthy?
A. Seo Kyung-seok: First of all, you can think of little medicine that improves the liver. Of course, it can be a little helpful. But if you eat anything, it can break down into your liver which can be poisonous. Therefore it's important to eat drugs a little less. And usually, when a healthy donor comes and tests it, 30 to 40 percent of them have fatty liver. Quite a few people have a fatty liver which can progress to cervical stools, so it is important to maintain a good weight and exercise properly.
In the case of drinking, it depends on the degree of quantity and the ability to break down the toxicity to alcohol varies considerably from person to person to person. In general, people who turn red or women have weak livers by nature. In that case, it can be poisonous to the liver even if they drink a little bit. In some cases, it is okay to drink a lot, but if you drink alcohol, the liver becomes tight and the blood flow does not go well, which can lead to complications such as anal inflammation and hemorrhoids. Usually, the liver can live b even if it is poisoned and dies 70 to 80 percent because it regenerates again. If you drink a lot once and then rest well, you can recover well. However, if you continue to attack without taking a break and get hurt before you get better, scar tissue will appear in the liver, and fiberization will occur leading to cirrhosis. As I'm a doctor, I can't advise you to drink, but it's good if you drink properly. But if you can't control it, I think it's better not to drink it. There are reports that people who are good at self-restraint are beneficial to their health, so it might be okay for them.
Q. Medieus Queen: Lastly, as a medical professor called a 'third-generation representative in the field of liver transplantation if you have anything you want to do in the future, please tell me.
A. Seo Kyung-seok: I think we have almost maintained the donor laparoscopic liver transplant surgery by distributing and standardizing it, but I think it is necessary to standardize it in the beneficiary surgery step by step. As a liver cancer professional, in particular, I have to think about ways to reduce the recurrence of liver cancer and make sure that people don't die from liver cancer. In the future, it would be best if the survival rate of liver cancer patients can be increased to 70-80% through early screening and appropriate treatment. And it is also important for me to train and lead juniors who can continue this kind of work in the future. Surgery that used to be completely impossible in the past is now possible and will eventually be standardized in the future. There will be more of those things in the future. I think it's another thing I'm going to do is to continue researching and developing.
A. Seo Kyung-seok: Professor at Seoul National University Hospital (hereinafter referred to as Seo Kyung-seok) I majored in surgery and I have mainly performed liver surgery so far since I was assigned in 1993. I conduct a lot of hepatic surgery and liver transplantation for patients with liver cancer or other liver diseases. In my case, I am in the department of hepatic pancreatic surgery, particularly I majored in the field of liver care and focused only on liver-related surgery, which allowed me to come up with various ideas. Seeing the case of death because there was no other treatment before, I decided to save the patient's life by developing surgery. I thought I'd develop a surgical method that would make it easier to get surgery and minimize the aftereffects and scarring.
I planned a new surgical method, saw the possibility through animal experiments several times, and then went into surgery. Through these processes, I developed several new surgical methods and saved several lives through continuous development such as laparoscopic surgery.
Q. Medieus Queen: I understand that you have recently succeeded in a pure laparoscopic-robot recipient liver transplant for the first time in the world. Please explain the background of the surgery that was known to be impossible, the factors that could have been possible, and the differences in the surgical method and complications compared to conventional surgery.
A. Seo Kyung-seok: Originally, liver transplant surgery involves a very large wound to the stomach, and sometimes the wound swells up. In the case of donors, as they have a normal condition, they should not go wrong after surgery. The liver function recovers after surgery, but I felt sorry that I didn't play the role of a doctor properly if there was an irreversible scar left. So to reduce the wound, we started laparoscopic surgery with the donor. Recently, it is called pure laparoscopic surgery, and the liver is taken out by making an incision into the panty line about 10 to 12cm after performing laparoscopic surgery to some extent. So the prognosis is so good that some people can't find surgical marks.
In fact, liver transplantation using this laparoscope is a very difficult operation. There should be no bleeding, blood vessels or biliary tract should be completely separated, and resection should be done while maintaining well without causing any wounds. However, in our hospital, the operation through laparoscopy is standardized to use by almost 90% of the donors. We have done more than 100, 200, and 500 surgeries, and personally, I did about 400 surgeries, so I did it the most. In the meantime, through an accurate understanding of technology and know-how, especially anatomy, donor surgery has become more and more developed and standardized. So, even though it is difficult, it is applied to beneficiaries.
The donor's liver is usually in good condition, so there is no big problem with surgery. On the other hand, the beneficiary's liver is particularly tricky and more difficult for the operation than the donor's because it has a mild stool, and does not coagulate blood. And also, we should not touch the enlarged blood vessels called varicose veins. The surgical method is to remove the removed the through inside the panty line like a donor, and put the donor's liver back there through laparoscopic surgery. Or you have to anastomosis, and you can smooth the process of attaching blood vessels with a robot. In particular, it can be advantageous to use a robot because it connects 2 to 3mm of arteries. Through this method, the patient's recovery is faster and pain is reduced compared to conventional surgery. It's not completely standardized at the moment, and it's a surgical method that only our hospital is doing, but we need to develop it and gradually standardize it.
Q. Medieus Queen: Usually the donor is normal, but the recipients have diseases. Then the surgery will be very difficult. I don't think we can all do it just because patients want to have a laparoscopic liver transplant. Is there a case that's possible?
A. Seo Kyung-seok: I can't tell you exactly about that yet. First of all, if the liver is severely damaged, and there are too many ascites or varicose which make it difficult to secure enough blood vessels, it is hard to operate. Usually, there are cases where blood clots are full in the context of the connection or the hepatic vein. In this case, it is hard to operate because we have to dig it out. I think it can be partially performed in patients who have improved their function to some extent and do not have a lot of toxins. As the liver transplant itself is a life-saving operation, the priority is to save lives regardless of the wound. And there aren't many cases yet. For now, it is important to target only those who are in the proper condition for the operation. It will take more time in the future, but it will be possible for most patients when it develops gradually when experiences of donor laparoscopic liver transplantation are accumulated.
Q. Medieus Queen: I understand that liver transplantation rates are very low among all liver cancer patients. Why is it low?
A. Seo Kyung-seok: Liver transplantation is recognized as the best treatment for patients with liver cancer or terminal liver disease. You only have to do it with early cancer to get good results by liver transplantation. There are conditions that apply. If one tumor is less than 5cm, or if there are many, up to 3 tumors should be less than 3cm and there should be no metastasis to other organs. When these conditions are met, the survival rate is 75 to 80%. It is a very good grade, but if it exceeds the conditions, the recurrence rate may be high and the survival rate may decrease. So if you quickly detect liver cancer at an early stage, it is considered that liver cancer is to be treated by liver transplantation.
But there's also the issue of giving. In other countries, there are quite a few dead liver transplants. In Korea, the number of donors is very small compared to the number of patients, but dead liver transplants are generally not possible for patients with healthy liver cancer. Most liver cancer patients now have a biological liver transplant because the priority goes to those with worse liver in case of a lack of scores. It's legally defined, and it's regulated. So it needs to be detected early and needs a donor. Because of these two conditions, not everyone can still have a liver transplant. And I think it's better to remove it as a primary treatment if possible because the hepatic agent performance is still excellent in single-tumor cancer cell patients and liver transplantation can be considered after recurrence.
Q. Medieus Queen: I understand that after liver transplantation, biliary tract complications occur between 15% and 50% of transplant patients. What are the causes and treatments for these complications?
A. Seo Kyung-seok: One of the most worrisome things about transplanting people is that after they were discharged from the hospital because the surgery went well, they visit an outpatient clinic and find that there are some problems in liver function and the biliary tract stenosis may occur. The biliary tract is a structure in which bile flows, and it's very irritating, so if the bile flows into the abdominal cavity, the patient is very sick and it worsens and clogs the surrounding tissue. And in the case of beneficiaries, since they have previous diseases, the quality of the biliary tract itself and the distribution of blood vessels may be so bad that biliary tract stenosis is likely to occur. Therefore, biliary tract stenosis occurs due to these various causes, and some patients often continue to suffer from it. After repeated hospitalization, biliary tract inflammation occurs, and the fever goes up and down.
But it's getting a lot better recently. We have braces or these days, we use an endoscope to pierce them and keep them for a long time. In order to prevent biliary tract complications, surgery should be done well first. We are still studying how to insert bile drainage tubes to help blood flow well and prevent bile leakage.
Q. Medieus Queen: Many patients have difficulty managing infections and side effects from taking immunosuppressants after liver transplantation. What should I take care of or be careful of after liver transplantation? Also, I wonder if it is okay to get a COVID-19 vaccine while taking immunosuppressants.
A. Seo Kyung-seok: You still have to take immunosuppressants for life after transplantation. Of course, some people quit immunosuppressants, but they generally have to take them for life. Immunosuppressants have improved a lot, but they cause patients more vulnerable to infection than ordinary people because their immunity is suppressed. And there is a high possibility of cardiovascular disease due to the side effects of the drug itself. Blood pressure may rise, and lipids may deteriorate, causing diabetes. The incidence of cancer is also high, so it is important to prepare well and prevent it.
The most important thing is to follow the rules of life. You have to keep your weight well and exercise. Regular checkups are also important.
As for COVID-19 vaccination, the probability of antibodies being created is significantly lower than that of the general people due to immunosuppressants. In most cases, less than 50% of antibodies are created when inoculated up to the second shot. In some cases, they need to be vaccinated to rise to a certain level only after 3rd shot.
Q. Medieus Queen: Is there a way to keep your liver healthy?
A. Seo Kyung-seok: First of all, you can think of little medicine that improves the liver. Of course, it can be a little helpful. But if you eat anything, it can break down into your liver which can be poisonous. Therefore it's important to eat drugs a little less. And usually, when a healthy donor comes and tests it, 30 to 40 percent of them have fatty liver. Quite a few people have a fatty liver which can progress to cervical stools, so it is important to maintain a good weight and exercise properly.
In the case of drinking, it depends on the degree of quantity and the ability to break down the toxicity to alcohol varies considerably from person to person to person. In general, people who turn red or women have weak livers by nature. In that case, it can be poisonous to the liver even if they drink a little bit. In some cases, it is okay to drink a lot, but if you drink alcohol, the liver becomes tight and the blood flow does not go well, which can lead to complications such as anal inflammation and hemorrhoids. Usually, the liver can live b even if it is poisoned and dies 70 to 80 percent because it regenerates again. If you drink a lot once and then rest well, you can recover well. However, if you continue to attack without taking a break and get hurt before you get better, scar tissue will appear in the liver, and fiberization will occur leading to cirrhosis. As I'm a doctor, I can't advise you to drink, but it's good if you drink properly. But if you can't control it, I think it's better not to drink it. There are reports that people who are good at self-restraint are beneficial to their health, so it might be okay for them.
Q. Medieus Queen: Lastly, as a medical professor called a 'third-generation representative in the field of liver transplantation if you have anything you want to do in the future, please tell me.
A. Seo Kyung-seok: I think we have almost maintained the donor laparoscopic liver transplant surgery by distributing and standardizing it, but I think it is necessary to standardize it in the beneficiary surgery step by step. As a liver cancer professional, in particular, I have to think about ways to reduce the recurrence of liver cancer and make sure that people don't die from liver cancer. In the future, it would be best if the survival rate of liver cancer patients can be increased to 70-80% through early screening and appropriate treatment. And it is also important for me to train and lead juniors who can continue this kind of work in the future. Surgery that used to be completely impossible in the past is now possible and will eventually be standardized in the future. There will be more of those things in the future. I think it's another thing I'm going to do is to continue researching and developing.
#Medieus #Interview #GamdamPancreaticSurgicalName #Seoul National UniversityHospital #SeoKyungseok #Liver cancer #Leveral liver transplantation #Hepatitis #TransplantSideeffect #ImmuneInhibitory # BiliaryTractComplications#KoreanRenowedDoctor# #RenowenDoctorInterview #RenowedDoctorRecommendation#RenownedDoctorSearch #Interview #MDUS
 |
CEO 박보현
메디컬 커머셜 플랫폼, 메디우스 (주)비앤에이치코리아 대표이사
국내최고 디지털마케팅 전문가
[월간 CEO&] 의료전문 컬럼니스트
인터뷰 문의:sales@bnhkorea.co.kr
|