[The current state of laparoscopic surgery for abdominal parenchymatous organs]

Laparoscopic surgery for abdominal parenchymatous organs such as the liver and pancreas presents unique technical challenges and anatomic difficulties although laparoscopic splenectomy has become the standard procedure in some hospitals. The advances in laparoscopic technology have encouraged expert hands to extend the procedure to parenchymatous organs. Clinical cases of laparoscopic hepatectomy, as well as laparoscopic thermal ablation, for patients with hepatic tumor have been increasing recently. The most important considerations for laparoscopic hepatectomy are the clinical characteristics of the tumor. Tumors that are smaller than 5 cm and located in the lower or left lateral segment are good candidates. At present, partial hepatectomy and left lateral segmentectomy are appropriate operative procedures. The laparoscopic approach is considered the treatment of choice, as it is less invasive in selected patients. Laparoscopic pancreatectomy is difficult to evaluate at present because of the scarcity of clinical cases. Laparoscopic pancreatectomy is indicated for distal, enucleated tumors. Another procedure, pancreatic cystogastrostomy, utilizes an intragastric approach. Laproscopic splenectomy will be the standard procedure in patients suffering hematologic disease, although it remains controversial in cases of splenomegaly due to the possibility of portal hypertension or hematologic malignancy. The incidence of conversion to open laparotomy due to uncontrollable bleeding is closely related to the technical skill of the surgeon. Safer laparoscopic procedures for abdominal parenchymatous organs depends on further refinement of endoscopic technology and improved training in endoscopic techniques.