Laparoscopic resection of liver tumor - for beneficial, reliable and successful surgery

Liver resection has been demonstrated as the preferable initial treatment for patients with resectable liver tumor. We have suggested that the laparoscopic liver resection (LLR) can provide favorable outcome with early postoperative recovery in selected patients received left lateral sectionectomy or partial hepatectomy in infero-lateral region of the liver. Development of instrument and technical refinement with effective usage of maginified-caudal view have contributed to overcome limitation of LLR. Advanced liver procedures, such as hepatectomy for tumor located postero-superior region of the liver or anatomy oriented resections including major hepatectomy, have been utilized by stepwise practice with a backup of a hand assisted or a laparoscopy assisted procedures, toward totally laparoscopic. With accumulation of experience, repeated hepatectomies or resection of multiple tumors could be performed safely in selected patient by preopearative simulation using diagnostic modalities. Due to the minimally invasiveness, we have also found that these LLR is beneficial in elderly or patients with co-morbidity under stringent perioperative management. For younger surgeons, all fundamental technique to perform reliable liver resection, such as maintenance of operative field, choice and appropriate use of instruments, isolation and division of vessels, control hemostasis should be structurally educated in both open and laparoscopic. Additionally, the important issue to reach maturity as a team to achieve successful LLR is to share the recognition and experience of both knack and pitfall of LLR.