[Milestones in liver surgery]

Area of Science:

• Hepatobiliary Surgery
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Liver surgery has seen rapid development, with a focus on advancements post-2000.
• Key developments include new indications, bloodless techniques, and vascular exclusion of the liver.

Purpose of the Study:

• To present the newest principles and novelties in liver surgery since the second millennium.
• To analyze and evaluate novel techniques such as ALPPS and tumor downsizing.
• To compare open, laparoscopic, and robotic liver surgery outcomes.

Main Methods:

• Analysis of recent principles and novelties in liver surgery.
• Comparative evaluation of open, laparoscopic, and robotic surgical approaches.
• Review of complication scoring systems for standardization.

Main Results:

• Associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) is a highly effective liver regeneration method.
• Laparoscopic liver surgery is now the preferred method based on evidence.
• Robotic liver surgery requires further data to establish its clinical role.
• Mortality rates have decreased to 1%, with ongoing efforts to standardize morbidity assessment.

Conclusions:

• Liver surgery has evolved with new techniques and minimally invasive approaches.
• Standardization of complication assessment and addressing global healthcare inequalities are crucial.
• Multidisciplinarity and international collaboration are key to advancing liver surgery.