Minimally Invasive Approach Used to Remove Liver Cyst from Tiny Infant

Before baby Anushka was born, doctors in Chicago's western suburbs discovered a growth on her liver during a routine ultrasound. While she was in the womb, physicians could not make a definitive diagnosis. But she was otherwise healthy and was delivered without problems, along with her fraternal twin.

The cyst on Anushka's liver is clearly visible in this scan.

After her birth, David Yousefzadeh, MD, a specialist in pediatric radiology at the University of Chicago Comer Children's Hospital, was asked to examine the mass on Anushka's liver using MRI and CT scans. After reviewing the scans, Dr. Yousefzadeh and Donald Liu, MD, PhD, surgeon-in-chief at Comer, confirmed that the growth was a choledochal cyst, a growth that blocks the bile ducts and prevents proper drainage of the liver. The condition can cause repeated liver infections, which can eventually lead to liver failure and, in some cases, death. Some patients with the cyst, if left untreated, are often later diagnosed with cancer.

"No one really knows what causes this," Dr. Liu said, "just bad luck." The condition is more common in Southeast Asia, but cases are not unheard of in the United States.

Donald Liu, MD, PhD

Though Anushka was only a few months old and had not had any liver infections yet, the cyst continued to grow and the Comer team decided to operate. Dr. Liu, who has performed this surgery on children in the United States and in Shanghai, China, knew that she would be the smallest, youngest patient for which he -- or perhaps anyone else -- had done such a procedure using minimally invasive technology. But Liu and his team of experts were confident they could perform the difficult operation.

Using a few keyhole-size incisions about 3 to 5 mm wide each, doctors completed the surgery without a major incision. They carefully removed the mass from Anushka's liver, avoided the crucial veins and arteries running to and from the organ, and were able to reconstruct a bile duct using part of the baby's intestines. Anushka went home from the hospital days later and has recovered quickly and completely.

Minimally invasive surgery offers several advantages over conventional surgery, including:

• less injury to tissue
• less pain
• reduced blood loss
• faster recovery
• shorter hospital stays
• quicker return to school and activities
• less scarring

The surgery on Anushka, who was not quite 7 months old at the time and weighed a mere 12 pounds, was a complete success. Within days, her father said she was recovering well. Two months later, Dr. Liu reports that she is thriving. "She's eating, she's playful and her liver growth is normal," he said. Her scars from the surgery are tiny and eventually will be nearly invisible.

Physicians at Comer Children's Hospital sharpen their skills in minimally invasive surgeries and their interdisciplinary teamwork, with surgeons, nurses, radiologists and many others working together to plan and perform procedures every day. Anushka's surgery proves that for the staff at Comer Children's Hospital, neither age nor size prevents any patient getting the best possible care.