| Background: Since 1990’s, we have suggested that the laparoscopic liver resection (LLR) can provide favorable outcome with early postoperative recovery in selected patients with liver disease received Minor LLRs, such as left lateral sectionectomy or partial hepatectomy in antero-lateral region of the liver. Development of instruments and technical refinement with effective usage of magnified-caudal endoscopic view, have contributed to overcome limitation of LLR. With accumulation of our experience, advanced procedures, such as hepatectomy for tumor located postero-superior region or anatomy oriented resections including Major LLRs have been utilized.Surgical technique: All fundaments to perform LLR, such as maintenance of operative field, choice and use of instruments, isolation and division of vessels, control hemostasis could be learned in Minor LLRs. Hilar dissection of hepatic inflow vessels is performed in anatomical liver resection. In our concept, individual isolation approach is used for hemi-hepatectomy, and Glissonean pedicle approach is used for anatomical hepatectomy smaller than hemi-hepatectomy. As well as technical stylization, perioperative diagnostic modality, such as 3D-CT, contrast enhancement US and Indocyanine green fluorescence imaging, can help to have decision in disease diagnosis, trocar insertion and way of liver transection. Results: Two hundred Sixty patients received LLR. No severe postoperative morbidity above Clavien-Dindo Grade IIIb except one patient developed cerebral infarction, was observed. Conclusion: We believe that benefits of LLR are not only minimally invasiveness, but also precise performance of surgery. The accumulation of each Minor contrivance leads to major progress toward reliable LLR. |
