With many reports on encouraging outcomes for HCC, laparoscopic liver resection has been accepted as attractive option for treatment for liver malignancy including HCC. However, still laparoscopic liver resection is still considered as difficult procedure, especially for major resection. The 1st and 2nd consensus meeting on laparoscopic liver resection has stated that major resection has a still risk associated with its novelty. And there are several limits in technical aspects. When the tumor is located at postero-superior area, it is still difficult to perform laparoscopic liver resection. There is also the limit in control bleeding when it occurs. However, with the accumulation on the experiences of laparoscopic liver resection, this procedure is more easily performed than before. Anatomic liver resection has been reported to have oncological benefit. And there are reports that remnant liver ischemia after liver resection has adverse effect on survival. When there is no remnant liver ischemia, the survival outcomes is better. Therefore, parenchymal resection should follow along the landmark of anatomic area without leaving ischemic or congested area.. Now, most of laparoscopic surgeon prefers anatomic liver resection over non-anatomic liver resection. There are several ways to perform anatomic liver resection. One is Glissonean pedicle approach and another is dye injection method. Recently ICG dye has been well used for anatomic liver resection. The technique of LLR also develops with the equipment. 3D or 4K image facilitate more precise transection. Preciseness and meticulousness are important in LLR. The techniques will be descended to junior surgeons with training system and educational program. Although, there are several surgeons who are using robots for LLR, there are still no definite advantages of robot over conventional laparoscopy.
With the evident advantage associated with minimal invasive surgery, more MIS liver resection will prevail in the future. |
