Giuliano Testa, MD, FACS; Joseph N. Michelotti, MD, MA, FACS
Liver hemangiomas are most commonly incidental and stable lesions. Although highly vascular tumors, they are benign and, in the absence of traumatic hemorrhage or excessive growth, rarely produce symptoms. Experienced surgeons are prudent to avoid approaching them surgically as they are not always well circumscribed and can be a source of considerable or uncontrollable blood loss. Benign neglect is considered the optimal treatment, but will occasionally allow this condition to grow into a massive problem. Very large liver hemangiomas can consume most of the liver parenchyma. Local symptoms can result from pressure on surrounding organs and arterio-venous shunting can cause cardiovascular compromise. Liver transplantation is an ultimate recourse, but the preferred operation for large symptomatic liver hemangiomas is resection, provided there is sufficient uninvolved liver tissue to support the patient's liver function, and the surgeon is able to negotiate the considerable technical challenges presented by the anatomic distortions that the size of these tumors can generate. This motion picture illustrates an operation to resect a very large benign hemangioma of the liver while sparing the left lateral liver segments and the patients liver function.