Perspectives and drawbacks of minimally invasive surgery for hepatocellular carcinoma

The need for an accurate intrahepatic staging is crucial for patients with hepatocellular carcinoma candidates to an aggressive surgical or ablative treatment. Currently available data indicate that laparoscopy with laparoscopic ultrasound provides information similar to that obtained by intraoperative ultrasound and it is able to identify small intrahepatic lesions not diagnosed by preoperative imaging techniques. Furthermore, laparoscopy with laparoscopic ultrasound also allows performance of ultrasound-guided biopsies or interstitial therapies as ethanol injection, cryoablation or radiofrequency thermal ablation in the same session. A laparoscopic segmentectomy or subsegmentectomy is technically feasible and safe in selected patients with small peripheral tumors. Combinations of resection and ablation may be required in certain cases, extending the indications for the laparoscopic approach to hepatocellular carcinoma in liver cirrhosis. The AA review the technical issues and the preliminary results of their experience in the field of minimally invasive approach to hepatocellular carcinoma. On the basis of these preliminary findings, laparoscopy with laparoscopic ultrasound seems to be useful to identify unsuspected new nodules and to help in choosing the most suitable treatment. In case of hepatocellular carcinoma not amenable to surgical resection, laparoscopic radiofrequency represents a safe and effective treatment above all when the percutaneous approach is difficult or impossible. Furthermore, laparoscopy with laparoscopic ultrasound could represent a sound preliminary examination in patients who are candidates to liver transplantation in order both to improve the staging and to guide an interstitial therapy as a bridge to the transplantation itself.