The standardization and trouble shooting in laparoscopic liver resection.

INTRODUCTION:
Laparoscopic liver resection (LLR) has been reported as a safe, minimally invasive, and effective approach to the management of liver tumor. The standardization of LLR is important in the performance of a safe and certain surgery. 
PATIENTS AND METHODS:
Between May 2010 and Dec 2020, 678 patients underwent LLR. Left side and right side LLR were underwent in supine and semi-left lateral decubitus position, respectively. The most frequent intraoperative complication during LLR is bleeding. Arterial or portal bleeding is controlled by Pringle maneuver. Pringle maneuver was prepared in 554 out of 678 cases. Venous bleeding is controlled by direct compression at first. Saline enhanced monopolar coagulation and tissue sealing sheet is useful. To exposure of the site of bleeding, saline irrigation is effective rather than suction. Temporary hemostasis is easily obtained by Endoscopic vascular clip for venous bleeding. HALS conversion is speedy and persists pneumoperitoneum. We could control bleeding by HALS conversion without laparotomy in consecutive 287 cases from 2017 until now. The most frequent postoperative complication is bile leakage. We always insert biliary drainage tube (C-tube) after controlling of the bile leakage by clipping or suturing. We have no postoperative bile leakage in consecutive 327 cases from 2016 until now.
CONCLUSION:
The standardization of LLR is equal to preparing recovery shot for intraoperative complication. Standardization of LLR and recovery shot improves safety of laparoscopic liver resection.