Landmarks and techniques to perform minimally invasive liver surgery: A systematic review with a focus on hepatic outflow

Abstract

In this systematic review, we aimed to clarify the useful anatomic structures and assess available surgical techniques and strategies required to safely perform minimally invasive anatomic liver resection (MIALR), with a particular focus on the hepatic veins (HVs). Methods: A systematic review was conducted using MEDLINE/PubMed for English articles and Ichushi databases for Japanese articles through September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 3372 studies were obtained, and 59 were selected and reviewed.Due to the limited number of published comparative studies and case series, the degree of evidence from our review was low. Thirty-two articles examined the anatomic landmarks and crucial structures for approaching HVs. Regarding the direction

Minimally invasive anatomic liver resection: Results of a survey of world experts

“…Moreover, in a systematic review conducted before PAM‐HBP Surgery, hepatic veins were evaluated as suitable landmarks. However, it was not easy to determine how to safely expose them 3 . Thus, we added a section to our survey that mentioned the importance of the hepatic veins as anatomic landmarks and inquired as to how experts identify and safely expose them.…”

“…However, this is still under discussion. Therefore, we firstly performed systematic reviews to obtain existing evidence 2‐4 . Next, we sought opinions from the selected experts throughout the world and explored a reasonable method for safely carrying out MIALR.…”

“…Anatomic liver resection (ALR) is defined as complete removal of the liver parenchyma confined within the responsible portal territory without leaving any ischemic or congested area. Despite the existence of systematic reviews of inflow/outflow control, and segmental borders in MIALR, before the Expert Consensus Meeting, “Precision Anatomy for Minimally Invasive Hepato‐Biliary‐Pancreatic Surgery” (PAM‐HBP Surgery), held in Tokyo in February 2021, there was no clear consensus on the safe implementation of MIALR 2‐4 . To discuss and establish clear standards for performing MIALR, we asked 28 questionnaires to selected experts from around the world who were attending PAM‐HBP Surgery to find out how they approach and perform MIALR.…”

Expert Consensus Guidelines: How to safely perform minimally invasive anatomic liver resection

“…The main limitation of this manuscript is that the recommendations are not based on high-level evidence. Although we have already reported systematic reviews, [2][3][4] there were no prospective randomized controlled trials in the literature reviews. Instead, most of the literature was categorized as "expert opinions" and "case series", which were evaluated as low-level evidence.…”

Author's Reply: Pure Laparoscopic Hepatectomy for Tumors Close to the Major Hepatic Veins: Intraparenchymal Identification of the Major Hepatic Veins using the Ventral Approach

“…The improved knowledge and informed choice of suitable surgical approaches may lead to improved surgical outcomes. More robust evidence is needed to determine the optimal surgical approach in various clinical scenarios and ultimately improve patient care [5].…”