Minimally invasive liver resections for malignancies: where is the limit?

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.