Gastrointestinal stromal tumors (GISTs) are the most common soft-tissue sarcoma of the gastrointestinal tract. Those found in the small bowel behave more aggressively than tumors originating in the stomach and confer a higher risk of metastases. Minimally invasive resection, including laparoscopic and robotic approaches, has been established as a safe and feasible alternative to conventional open resection for gastric GISTs, with improved perioperative morbidity and non-inferior oncologic outcomes. Data, however, are less established for small bowel tumors. Currently, there are emerging data suggesting that minimally invasive resection is a safe and feasible surgical option with similarly favorable outcomes for small bowel GISTs. Duodenal GISTs, rarer still, are a subset that offer unique anatomic challenges to minimally invasive resection. While minimally invasive approach for duodenal tumors has been described, data remains insufficient to draw clear conclusions on laparoscopic or robotic resection for GISTs located in the duodenum. Caution is merited to avoid overinterpretation of the current limited data. Future research to validate minimally invasive techniques for duodenal lesions is necessary. Regardless of minimally invasive approach, oncologic principles of resection apply. Surgical approach and oncologic planning are dependent on location and size of the tumor, with a range of surgical techniques illustrated in the literature. These techniques and surgical pearls are reviewed to guide technical decision making for these lesions. This narrative review aims to present the latest data on minimally invasive resection for small bowel and duodenal GISTs and discuss surgical considerations.
{"title":"Open versus laparoscopic treatment for small bowel gastrointestinal stromal tumors","authors":"Amy Y Li, B. Visser","doi":"10.21037/LS-20-90","DOIUrl":"https://doi.org/10.21037/LS-20-90","url":null,"abstract":"Gastrointestinal stromal tumors (GISTs) are the most common soft-tissue sarcoma of the gastrointestinal tract. Those found in the small bowel behave more aggressively than tumors originating in the stomach and confer a higher risk of metastases. Minimally invasive resection, including laparoscopic and robotic approaches, has been established as a safe and feasible alternative to conventional open resection for gastric GISTs, with improved perioperative morbidity and non-inferior oncologic outcomes. Data, however, are less established for small bowel tumors. Currently, there are emerging data suggesting that minimally invasive resection is a safe and feasible surgical option with similarly favorable outcomes for small bowel GISTs. Duodenal GISTs, rarer still, are a subset that offer unique anatomic challenges to minimally invasive resection. While minimally invasive approach for duodenal tumors has been described, data remains insufficient to draw clear conclusions on laparoscopic or robotic resection for GISTs located in the duodenum. Caution is merited to avoid overinterpretation of the current limited data. Future research to validate minimally invasive techniques for duodenal lesions is necessary. Regardless of minimally invasive approach, oncologic principles of resection apply. Surgical approach and oncologic planning are dependent on location and size of the tumor, with a range of surgical techniques illustrated in the literature. These techniques and surgical pearls are reviewed to guide technical decision making for these lesions. This narrative review aims to present the latest data on minimally invasive resection for small bowel and duodenal GISTs and discuss surgical considerations.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42450469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Cipriani, F. Ratti, G. Fiorentini, L. Aldrighetti
Hilar cholangiocarcinoma has a severe prognosis and surgical treatment represents the only chance for cure. Unfortunately, surgery for Klatskin tumours is technically challenging as it often requires major liver resection and caudatectomy concomitant to the bile duct resection, standard lymphadenectomy, and ultimate assessment of resectability. Minimally-invasive techniques have been applied to almost all fields of hepatobiliary surgery with satisfactory intraoperative outcomes and advantages for patients. However, for hilar cholangiocarcinomas are the last area of resistance, since multiple difficult procedures need to be combined in a single operation. The objective of the study was to conduct a review of the available literature on minimally invasive liver resections for hilar cholangiocarcinoma. A literature search was performed in the PubMed database. The search words were (“Klatskin” OR “hilar cholangiocarcinoma”) AND (“laparoscopic” OR “minimally-invasive” OR “robotic” OR “robot-assisted”). Language restriction was applied to include only English literature, and publications up to March 2020 were considered. For both pure laparoscopy and robotics there are limited publications, mainly addressing the safety and feasibility in the setting of selected patients and carried out at expert centres. Data on operations requiring associated liver resections are still scant and scattered among case reports, small case series, and a handful of comparative studies. However, the preliminary data are promising. Conversion rates are acceptable, with most of the authors excluding from this approach locally advanced tumours such as Bismuth type IV or vascular invasion. Long operative time are expected decrease with experience, and no major intraoperative accidents have been reported. There are initial data on possible postoperative advantages in terms of reduced complications and length of stay; the robotic approach may facilitate difficult bilioenteric anastomoses and reduce postoperative bile leaks. The adequacy of lymphadenectomy and radical resections seems to be preserved, but long-term oncological data still lack. In conclusion, it is advocated further research on this topic to include a larger number of patients, standardize the technique especially for the most difficult steps and refine the reconstructive phase. However, the actual data should not foster theoretical hostility toward the implementation of minimally-invasive techniques in this setting, but rather support its stepwise advancements in expert centres.
{"title":"Minimally invasive liver resections for hilar cholangiocarcinoma: a narrative review","authors":"F. Cipriani, F. Ratti, G. Fiorentini, L. Aldrighetti","doi":"10.21037/LS-20-95","DOIUrl":"https://doi.org/10.21037/LS-20-95","url":null,"abstract":"Hilar cholangiocarcinoma has a severe prognosis and surgical treatment represents the only chance for cure. Unfortunately, surgery for Klatskin tumours is technically challenging as it often requires major liver resection and caudatectomy concomitant to the bile duct resection, standard lymphadenectomy, and ultimate assessment of resectability. Minimally-invasive techniques have been applied to almost all fields of hepatobiliary surgery with satisfactory intraoperative outcomes and advantages for patients. However, for hilar cholangiocarcinomas are the last area of resistance, since multiple difficult procedures need to be combined in a single operation. The objective of the study was to conduct a review of the available literature on minimally invasive liver resections for hilar cholangiocarcinoma. A literature search was performed in the PubMed database. The search words were (“Klatskin” OR “hilar cholangiocarcinoma”) AND (“laparoscopic” OR “minimally-invasive” OR “robotic” OR “robot-assisted”). Language restriction was applied to include only English literature, and publications up to March 2020 were considered. For both pure laparoscopy and robotics there are limited publications, mainly addressing the safety and feasibility in the setting of selected patients and carried out at expert centres. Data on operations requiring associated liver resections are still scant and scattered among case reports, small case series, and a handful of comparative studies. However, the preliminary data are promising. Conversion rates are acceptable, with most of the authors excluding from this approach locally advanced tumours such as Bismuth type IV or vascular invasion. Long operative time are expected decrease with experience, and no major intraoperative accidents have been reported. There are initial data on possible postoperative advantages in terms of reduced complications and length of stay; the robotic approach may facilitate difficult bilioenteric anastomoses and reduce postoperative bile leaks. The adequacy of lymphadenectomy and radical resections seems to be preserved, but long-term oncological data still lack. In conclusion, it is advocated further research on this topic to include a larger number of patients, standardize the technique especially for the most difficult steps and refine the reconstructive phase. However, the actual data should not foster theoretical hostility toward the implementation of minimally-invasive techniques in this setting, but rather support its stepwise advancements in expert centres.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46617043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic liver resection (LLR) has been disseminated in the last two decades because of the development of devices and improvement of techniques. Its effectiveness and safety have already been reported. In addition, oncological outcomes in LLR for hepatocellular carcinoma and colorectal liver metastases were reported to be similar to those of open surgery in selected cases. The indications for LLR have gradually expanded, and currently, highly challenging procedures including major hepatectomy are applied. However, there are several limitations to LLR in terms of technical aspects, tumor characteristics, and so on because much prolongation of the operation time and increase in the risks should not be permitted. For hepatectomy in which severe complications easily develop, it is most significant to minimize the operative complications. The indication criteria for LLR should be rigorously determined with an understanding of the limitations of laparoscopic surgery.
{"title":"Minimally invasive liver resections for malignancies: where is the limit?","authors":"Y. Ome, G. Honda, Yusuke Kawamoto, N. Yoshida","doi":"10.21037/LS-20-59","DOIUrl":"https://doi.org/10.21037/LS-20-59","url":null,"abstract":"Laparoscopic liver resection (LLR) has been disseminated in the last two decades because of the development of devices and improvement of techniques. Its effectiveness and safety have already been reported. In addition, oncological outcomes in LLR for hepatocellular carcinoma and colorectal liver metastases were reported to be similar to those of open surgery in selected cases. The indications for LLR have gradually expanded, and currently, highly challenging procedures including major hepatectomy are applied. However, there are several limitations to LLR in terms of technical aspects, tumor characteristics, and so on because much prolongation of the operation time and increase in the risks should not be permitted. For hepatectomy in which severe complications easily develop, it is most significant to minimize the operative complications. The indication criteria for LLR should be rigorously determined with an understanding of the limitations of laparoscopic surgery.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44567982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ortenzi, A. Balla, G. Fontana, Federica Marinucci, A. Reggiani, Perla Capomagi, Beatrice Bailetti, G. Lezoche, M. Guerrieri
Clinica Chirurgica, Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy; Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza University of Rome, Rome, Italy Contributions: (I) Conception and design: M Ortenzi; (II) Administrative support: M Ortenzi; (III) Provision of study materials or patients: M Ortenzi; (IV) Collection and assembly of data: M Ortenzi, G Fontana, F Marinucci, A Reggiani, P Capomagi, B Bailetti; (V) Data analysis and interpretation: M Ortenzi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Monica Ortenzi. Clinica Chirurgica, Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy. Email: monica.ortenzi@gmail.com.
{"title":"Factors influencing recurrence after minimally invasive treatment of hiatal hernia—a single center experience","authors":"M. Ortenzi, A. Balla, G. Fontana, Federica Marinucci, A. Reggiani, Perla Capomagi, Beatrice Bailetti, G. Lezoche, M. Guerrieri","doi":"10.21037/ls-20-63","DOIUrl":"https://doi.org/10.21037/ls-20-63","url":null,"abstract":"Clinica Chirurgica, Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy; Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza University of Rome, Rome, Italy Contributions: (I) Conception and design: M Ortenzi; (II) Administrative support: M Ortenzi; (III) Provision of study materials or patients: M Ortenzi; (IV) Collection and assembly of data: M Ortenzi, G Fontana, F Marinucci, A Reggiani, P Capomagi, B Bailetti; (V) Data analysis and interpretation: M Ortenzi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Monica Ortenzi. Clinica Chirurgica, Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy. Email: monica.ortenzi@gmail.com.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49416089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minimally invasive surgery in liver malignancies has always been a challenge to surgeons. Although laparoscopic liver resection had been proved feasible and safe, the steep learning curve indicates the difficulties itself. Robotic system arises to tackle the limitations of laparoscopic surgery with its unique features. Literature review of robotic liver resection in recent years on MEDLINE and PubMed was explored. The outcomes of surgical parameters, learning curve and feasibility were concluded in this review along with pros and cons of robotic liver resection. There are no significant differences in short-term perioperative outcomes regarding blood loss, morbidity and mortality rates and hospital stay. The longterm outcomes of robotic liver resection have not been well analyzed. Robotic group had a significant higher proportion of major hepatectomies and resection of tumors located at posterosuperior segments compared with laparoscopic group. Robotic liver resection is considered as feasible and safe in experienced hands. Its featured instrument advantages allow surgeon to tackle problems encountered in laparoscopic procedures and to advance to other disease entities. A dedicated team proficient in equipment, surgical expertise and well-established proctorship are key factors in implementation of clinical use. Large scale multicenter randomized control trials are still mandated to draw definite conclusions.
{"title":"Robotic resection in liver malignancies","authors":"C. Lin","doi":"10.21037/LS-20-58","DOIUrl":"https://doi.org/10.21037/LS-20-58","url":null,"abstract":"Minimally invasive surgery in liver malignancies has always been a challenge to surgeons. Although laparoscopic liver resection had been proved feasible and safe, the steep learning curve indicates the difficulties itself. Robotic system arises to tackle the limitations of laparoscopic surgery with its unique features. Literature review of robotic liver resection in recent years on MEDLINE and PubMed was explored. The outcomes of surgical parameters, learning curve and feasibility were concluded in this review along with pros and cons of robotic liver resection. There are no significant differences in short-term perioperative outcomes regarding blood loss, morbidity and mortality rates and hospital stay. The longterm outcomes of robotic liver resection have not been well analyzed. Robotic group had a significant higher proportion of major hepatectomies and resection of tumors located at posterosuperior segments compared with laparoscopic group. Robotic liver resection is considered as feasible and safe in experienced hands. Its featured instrument advantages allow surgeon to tackle problems encountered in laparoscopic procedures and to advance to other disease entities. A dedicated team proficient in equipment, surgical expertise and well-established proctorship are key factors in implementation of clinical use. Large scale multicenter randomized control trials are still mandated to draw definite conclusions.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48244638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ablation is an exciting alternative to surgery as a curative intent treatment for primary and metastatic liver cancer. However, conventional techniques have not achieved oncologic outcomes equal to surgery except in a minimal subset of patients. We discuss here our use of a stereotactic technique for RFA and summarize the available clinical evidence for this approach to make oncological outcomes of ablation therapy comparable to surgery. Even with promising results, we are the only institution performing this approach, and similar approaches are only made in a few centers worldwide. The causes for that are multifactorial, but reimbursement of percutaneous ablation seems to be the most significant limiting factor for this technology becoming mainstream. Nonetheless, the question to answer is: will stereotactic liver ablation replace minimally invasive liver resection? In our opinion, stereotactic liver ablation will change the way we treat primary and metastatic liver cancer, but ideally, by adding another viable and consistent minimally invasive option. The objective is offering curative intent treatments to more patients and making open procedures become a last resort option. To get there, surgeons and interventional radiologists have to work together to create the clinical evidence and knowhow to make this a reality.
{"title":"Narrative review of 3D navigated stereotactic liver ablation—do we still need a minimally invasive liver surgeon?","authors":"R. Bale, P. Schullian, Amilcar Alzaga","doi":"10.21037/LS-20-107","DOIUrl":"https://doi.org/10.21037/LS-20-107","url":null,"abstract":"Ablation is an exciting alternative to surgery as a curative intent treatment for primary and metastatic liver cancer. However, conventional techniques have not achieved oncologic outcomes equal to surgery except in a minimal subset of patients. We discuss here our use of a stereotactic technique for RFA and summarize the available clinical evidence for this approach to make oncological outcomes of ablation therapy comparable to surgery. Even with promising results, we are the only institution performing this approach, and similar approaches are only made in a few centers worldwide. The causes for that are multifactorial, but reimbursement of percutaneous ablation seems to be the most significant limiting factor for this technology becoming mainstream. Nonetheless, the question to answer is: will stereotactic liver ablation replace minimally invasive liver resection? In our opinion, stereotactic liver ablation will change the way we treat primary and metastatic liver cancer, but ideally, by adding another viable and consistent minimally invasive option. The objective is offering curative intent treatments to more patients and making open procedures become a last resort option. To get there, surgeons and interventional radiologists have to work together to create the clinical evidence and knowhow to make this a reality.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44569833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is minimally invasive distal pancreatectomy a safe and effective oncologic resection?","authors":"R. Kim, E. Ceppa","doi":"10.21037/ls.2020.02.01","DOIUrl":"https://doi.org/10.21037/ls.2020.02.01","url":null,"abstract":"","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2020.02.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43577184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic common bile duct exploration (LCBDE) is a safe and effective technique for management of choledocholithiasis. Transcystic CBDE can be learned by housestaff and can be used to manage most patients with choledocholithiasis, reserving postoperative ERCP for unsuccessful transcystic CBDE and deferring choledochotomy for select situations (large stones, altered anatomy, etc.)
{"title":"Laparoscopic common bile duct exploration","authors":"T. Kelly, M. Parikh, H. Pachter","doi":"10.21037/ls.2019.12.06","DOIUrl":"https://doi.org/10.21037/ls.2019.12.06","url":null,"abstract":"Laparoscopic common bile duct exploration (LCBDE) is a safe and effective technique for management of choledocholithiasis. Transcystic CBDE can be learned by housestaff and can be used to manage most patients with choledocholithiasis, reserving postoperative ERCP for unsuccessful transcystic CBDE and deferring choledochotomy for select situations (large stones, altered anatomy, etc.)","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2019.12.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49579899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and the third leading cause of cancer-related deaths worldwide. Liver resection has been widely accepted as the mainstay of HCC treatment, leading to long-term survival in well-selected patients. Over the last two decades, laparoscopic liver resection (LLR) has developed worldwide parallel to technological advancements and increased experience of liver surgeons. Several meta-analyses revealed that LLR for HCC has yielded better short-term outcomes without compromising long-term outcomes, compared to open liver resection (OLR). During treatment of HCC patients with chronic liver disease or liver cirrhosis, LLR decreases blood loss and postoperative complications including refractory ascites, leading to a shorter hospital stay. In the treatment of recurrent HCC, LLR makes subsequent procedures easier by minimizing adhesion formation. The procedure of laparoscopic major liver resection (major LLR) is yet to be standardized and is still in exploration stage according to the Morioka international conference, 2014. Laparoscopic parenchyma-sparing anatomical liver resection (Lap-PSAR) is a novel surgical strategy to resect all malignant tissues while preserving enough liver parenchyma to prevent postoperative liver failure. In conclusion, LLR has many advantages for the treatment of HCC patients and generally results in better short-term outcomes. Further investigations are needed to standardize the procedures of major LLR and Lap-PSAR.
{"title":"A narrative review of minimally invasive liver resections for hepatocellular carcinoma","authors":"K. Mishima, G. Wakabayashi","doi":"10.21037/LS-20-100","DOIUrl":"https://doi.org/10.21037/LS-20-100","url":null,"abstract":": Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and the third leading cause of cancer-related deaths worldwide. Liver resection has been widely accepted as the mainstay of HCC treatment, leading to long-term survival in well-selected patients. Over the last two decades, laparoscopic liver resection (LLR) has developed worldwide parallel to technological advancements and increased experience of liver surgeons. Several meta-analyses revealed that LLR for HCC has yielded better short-term outcomes without compromising long-term outcomes, compared to open liver resection (OLR). During treatment of HCC patients with chronic liver disease or liver cirrhosis, LLR decreases blood loss and postoperative complications including refractory ascites, leading to a shorter hospital stay. In the treatment of recurrent HCC, LLR makes subsequent procedures easier by minimizing adhesion formation. The procedure of laparoscopic major liver resection (major LLR) is yet to be standardized and is still in exploration stage according to the Morioka international conference, 2014. Laparoscopic parenchyma-sparing anatomical liver resection (Lap-PSAR) is a novel surgical strategy to resect all malignant tissues while preserving enough liver parenchyma to prevent postoperative liver failure. In conclusion, LLR has many advantages for the treatment of HCC patients and generally results in better short-term outcomes. Further investigations are needed to standardize the procedures of major LLR and Lap-PSAR.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48995993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic liver resection (LLR) has evolved over the last two decades to offer patients the potential benefits of less post-operative pain, shorter hospital stay and improved cosmesis. Blood loss and morbidity appear to be less, while oncologic outcomes are similar to those achieved by open techniques in trials analyzing non major liver resections. Liver surgery embraces a broad array of procedures from simple to complex, and although many surgeons perform minor resections, the widespread adoption of LLR for major resections remains somewhat limited; mostly due to fear of bleeding or oncological concerns. This paper explores the development of LLR over the last 20 years, focusing on the people involved in the advances and the technical and educational improvements they instituted. Surgeons should begin LLR in a stepwise approach beginning with small peripheral lesions in favorable segments before progressing to more complex hepatic resections.
{"title":"Laparoscopic hepatic resection","authors":"D. Brough, N. O’Rourke","doi":"10.21037/ls.2020.02.02","DOIUrl":"https://doi.org/10.21037/ls.2020.02.02","url":null,"abstract":"Laparoscopic liver resection (LLR) has evolved over the last two decades to offer patients the potential benefits of less post-operative pain, shorter hospital stay and improved cosmesis. Blood loss and morbidity appear to be less, while oncologic outcomes are similar to those achieved by open techniques in trials analyzing non major liver resections. Liver surgery embraces a broad array of procedures from simple to complex, and although many surgeons perform minor resections, the widespread adoption of LLR for major resections remains somewhat limited; mostly due to fear of bleeding or oncological concerns. This paper explores the development of LLR over the last 20 years, focusing on the people involved in the advances and the technical and educational improvements they instituted. Surgeons should begin LLR in a stepwise approach beginning with small peripheral lesions in favorable segments before progressing to more complex hepatic resections.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2020.02.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43120582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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