ABSTRACT
Superficial Liver Disease In the usual case of advanced-stage disease, ovarian cancer is disseminated throughout the abdominal cavity by spreading along peritoneal surfaces and, as such, tends to involve only the liver surface. In these instances, cytoreduction of liver surface disease can be accomplished by simple resection using conventional techniques, excision with the CUSA, ablation with the argon beam coagulator, or a combination. For simple resection, electrocautery is used to demarcate a small margin of normal appearing tissue around the surface implant by circumferentially incising Glisson’s capsule. The margin around the tumor implant resection is placed on countertractionwith pickups or an Allis clamp, and electrocautery dissection continued within the substance of the superficial hepatic parenchyma (Fig. 16A-C). The resection bed of the liver surface is then treated with the argon beam coagulator to secure hemostasis (Fig. 16D). When excising surface implants along the reflection of the coronary ligament, it is important to ascertain the location of the vena cava and hepatic veins to avoid injury to the vessel wall. Resection of posterior surface disease in the region of Morrison’s pouch is facilitated by dividing the right triangular ligament and completely mobilizing the right side of the liver.
