Laparoscopic liver resection: a review of current indications and surgical techniques

Abstract

Laparoscopic liver resection (LLR) has been the most impressive development in the field of liver surgery in recent two decades. Technical innovations and experience accumulation have made LLR a safe and effective procedure with faster postoperative recovery. Despite the fast spreading of the procedure, details regarding the indications, oncological outcomes and technical essentials were still disputable. To address these issues, two international consensus conferences were hold to update the knowledge in this field. The statements of the both conferences were not conclusive and more high-quality researches are required. In this article, we reviewed the development and the current state of LLR. Indications, outcomes, surgical techniques and devices used in LLR were also discussed.

Laparoscopic Liver Resection of Segments 7 and 8: from the Initial Restrictions to the Current Indications

“…[37][38][39] Therefore, although at the beginning of laparoscopic liver surgery the approach of these segments was considered even as a contraindication, nowadays its performance is increasingly recommended in groups with experience in laparoscopic liver surgery. 40 To facilitate the surgical approach to these locations different technical modifications have been proposed.…”

Totally robotic caudate lobe liver resection: Bridge over troubled water

“…In blue (A), 12 mm periumbilical assistant trocar. In red (1–4) 8 mm robotic arms. Trocars 2 and 3 are alternately used for the camera…”

“…In the last 2 decades laparoscopic liver resection became a wellestablished approach with innumerous advantages over the traditional open approach. 1 Nevertheless, laparoscopy has some limitations related to the technology itself as tremor amplification, fixed fulcrum effect with rigid instruments at the ports, two-dimensional image adaptation to limited perception of depth, limited degree of motion and poor ergonomics, among others. 2 The robotic approach was developed to compensate these limitations imposed by the laparoscopic approach, allowing improved dexterity, better motion scaling, magnified three-dimensional view (also present in 3D-laparoscopy), elimination of fulcrum effect, increased degrees of freedom, elimination of tremors, better ergonomics for the surgeon and stable camera positioning and retraction of adjacent structures.…”

Laparoscopic liver resection for malignancies confined to Couinaud’s segment VII in the robotic surgery era

“…left lateral section (II-III) or anterior hepatic segments (IVb, V, VI) can be carried out through laparoscopic approach (1)(2)(3)(4)(5). Prominent healthcare centers offer hemihepatectomies, trisectionectomies and resections of posterosuperior segments (IVa, VII, VIII) and caudate (I), which are considered major liver resections (1,2,5). Major liver resections are seldom performed, even at leading centers, because of considerable technical complexities, risk of massive bleeding and positive tumor margins (1,2,5).…”

“…Prominent healthcare centers offer hemihepatectomies, trisectionectomies and resections of posterosuperior segments (IVa, VII, VIII) and caudate (I), which are considered major liver resections (1,2,5). Major liver resections are seldom performed, even at leading centers, because of considerable technical complexities, risk of massive bleeding and positive tumor margins (1,2,5). Segment VII and VIII tumors can be hardly reached by currently available laparoscopic instruments (1).…”