Techniques for performing laparoscopic liver resection in various hepatic locations.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoscopic liver resection (LLR) development has lagged behind other laparoscopic procedures.
• Indications for LLR were previously limited to easily accessible lesions.
• Posterior and superior liver resections were challenging due to exposure and dissection difficulties.

Purpose of the Study:

• To describe technical considerations for performing LLR.
• To highlight advancements enabling LLR in difficult locations.
• To detail LLR for postero-superior liver tumors.

Main Methods:

• Review of advancements in flexible endoscopy, high-definition imaging, and parenchymal transection devices.
• Accumulated clinical experience at multiple centers.
• Individualized patient positioning and trocar placement strategies.

Main Results:

• LLR is increasingly feasible in previously difficult locations, including postero-superior segments.
• Tumor location is no longer a primary limitation for LLR at the authors' institution.
• Technical considerations, including patient positioning and trocar placement, are crucial for safety.

Conclusions:

• Modern advancements and accumulated experience have expanded the applicability of LLR.
• Safe and effective LLR, even in challenging liver segments, is achievable.
• Individualized surgical planning is essential for successful LLR outcomes.