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"When I left Pittsburgh, I was con- templating how to solve this problem," he says. "Numerous papers had been written about it. At the University of Iowa in 1994, I came up with a solution: surgeons could use the hepatobiliary vein and the vena cava to form a cavaplasty to the transplant." By sparing the vena cava, cavaplasty reduces bleeding and blockage, eliminat- ing many surgical complications. Patients continue to receive blood from their lower extremities during removal of the liver, Dr. Wu explains, rendering them hemody- namically more stable. Cavaplasty makes liver transplant safer for patients who have cardiac issues or other conditions that make them unstable. "With this technique, not one patient has experienced outflow block," Dr. Wu says. "We can perform up to 30 percent of surgeries without the need for a blood transfusion. With an experienced team, I have completed the cavaplasty procedure in as little as 17 minutes." In the operating room, as on daily transplant rounds, it's "all hands on deck" at Westchester Medical Center. The full complement of surgeons is present for every transplant operation, Dr. Wu says, with each contributing to the procedure. "A good transplant operation team consists of senior, mid-level and junior surgeons," he says. "We always have a senior surgeon for quality and safety. These surgeons provide in-depth experi- ence. Junior surgeons have talent and strength. It's like distance runners and sprinters — there are advantages to each." Surgeons bring their experience in different settings to the procedure, Dr. Wu adds. "In the United States, surgeons move from hospital to hospital, bringing their best techniques and mixing them together," he says. "They respect each other, and, joining their ideas together and learning from one another, they jointly discover and perfect new techniques. That is the beauty of the system." "One-Stop Shop" for Hepatocellular Carcinoma Patients About half of liver transplant patients at Westchester Medical Center have hepatocellular carcinoma, or primary liver cancer. These patients' medical needs extend beyond the domain of surgery and hepatology, Dr. Veillette says. To accommodate them, Westchester Medical Center has created a "one-stop shop" where patients can make a single appointment to meet with multiple specialists and have the best course of treatment mapped out for them. "Surgery, medical oncology, inter- ventional radiology and hepatology all participate," Dr. Veillette says. "With long waits for donor livers in the New York area, patients wait a long time once they are listed for transplant, so we do the best we can to list them early." To do that, patients need a rapid dis- position of their cases. Some will need liver resection but not transplant; others will need a transplant following interim radiological treatment; still others will not be candidates for any kind of surgery due to the size of their tumor or the fact that their cancer has metastasized beyond the liver. Te s t s for hep ato cel lu l a r c a rc i- noma patients are scheduled almost immediately, and resection surger y generally takes place approximately Dr. Veillette prepares the hepatic artery down to the aorta to allow adequate length for arterial anastomosis. Dr. Veillette dissects the vena cava and hepatic veins to prepare for the cavaplasty procedure. M D N E W S . CO M ■ MD NEWS Mid Hudson | 9