Recent Advance in laparoscopic/robotic liver surgery

With the continuous advances of surgical experience, image system, preoperative simulation and instruments, laparoscopic liver resection (LLR) has been applied in wide and wide fields of HBP surgery.
Despite the current recommendation of LLR for patients with solitary tumor, less than 5 cm in diameter, without evident vascular invasion and extrahepatic spread.
More and more series of laparoscopic repeat liver resection for recurrent HCC or colorectal liver metastasis (CRLM) had been published and showed improved perioperative and early postoperative outcomes.
Sporadic reports had showed the feasibility and safety of LLR in HCC patients with larger tumors. Short term outcomes were comparable to those with smaller tumors.
Few reports also showed the feasibility of LLR for HCC with biliary tumor thrombus or major vascular invasion, at least, in hands of experienced experts. All these are based on precise preoperative image, simulation/planning and intraoperative tissue handling and dissection.
Some sporadic reports of hepatic vein reconstruction for HCC or CRLM with HV invasion had been found recently despite the extreme procedure complexity.
For lesions needed biliary reconstruction, pure laparoscopic/robotic resection were also published, showing the future potentials of minimally invasive liver resection.
Similar trend was also found in applying LLR for tumor with diaphragm invasion, showing the feasibility of combined resection and repair of diaphragm.
Although the long-term outcomes of all these attempts remain to be evaluated.
In some well experienced teams, the tumor location, number, and extent of resection were no longer the limitation of patient selection. More and more complex transection plane has been designed based on the better understanding of intrahepatic anatomy for tumors in various locations.
In conclusion, minimally invasive liver resection has gained more and more acceptance among liver surgeons. Recent advances in applying LLR in complex liver resections, for tumors beyond traditional recommendation and for lesions needed vascular/biliary reconstruction have been observed. However, further evaluation of long term results of these attempts is mandatory.