Laparoscopic Liver Resection Updates

With many reports on encouraging outcomes, laparoscopic liver resection has been accepted as attractive alternative for open liver resection. However, there are still several limitations on application of the procedure. First, laparoscopic liver resection has been limited to easily accessible lesions. Second, this procedure is not suitable when tumor is close to major hepatic vein or IVC. Third, this surgery is still not well indicated when the tumor size is large. As the experience with this procedure grows, its prior indications and contraindications can be changed accordingly.
The indications for laparoscopic liver resection have been limited to tumors in the peripheral portion of the antero-lateral segments of the liver. In contrast, lesions in the posterior or superior part of the liver (segments I, VII, VIII and the superior part of IV) are considered by most surgeons to be poor indications for laparoscopic liver resection. Flexible endoscopy, high definition imaging and various kinds of equipments for parenchymal transection have been introduced for clinical. With this instrument, inadequate exposure and poor operative field can be partly overcome. When the tumor is centrally located (tumor is close to major hepatic vein or IVC, performing laparoscopic liver resection has been considered contraindicated due to difficulty in bleeding control, risk of major hemorrhage. Recent development of instrument for parenchymal dissection has made laparoscopic liver resection more safe and meticulous than before. As for the limitations on tumor size, the present indications of tumor less than 5 cm may change due to the growing experience with laparoscopic procedures and the developments in laparoscopic devices.
The type of resection also may depend on the remaining liver’s functional capacity. The patients with HCC usually have poor liver function due to chronic liver disease or liver cirrhosis. Therefore it would be recommendable to resect as minimal as possible without jeopardizing oncologic safety. Anatomical liver resection may be advantageous in terms of preserving remaining liver volume and eradicating tumor completely in some cases. Anatomical liver resection can be performed in many ways. Glissonian pedicle approach is one method for anatomical liver