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Updated: Jun 22, 2025
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Minimally invasive tools are necessary for the modern practice of liver surgery
Young-Dong Yu1,2, Karim J Halazun3, Rohit Chandwani1
1Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA.
Introduction:
Minimally invasive liver resection (MILR) is performed for other gastrointestinal applications. At our centre, all liver resections are systematically performed using a minimally invasive approach. This study aimed to describe our experience in minimising open surgery and emphasised the importance of minimally invasive surgery.
Patients And Methods:
We retrospectively reviewed 260 patients who underwent liver surgery and compared the surgical outcomes between the open and MILR groups.
Results:
A total of 154 patients (68%) underwent MILR. The proportion of patients who underwent prior abdominal surgery and resection was higher in the open surgery group. However, the proportion of patients with liver cirrhosis was similar between the two groups. The MILR group was superior in terms of operative time, blood loss, Pringle manoeuvre rate and mean hospital stay. In addition, major complication and bile leak rates were lower in the MILR group. No significant differences in the tumour size, number of lesions or underlying liver pathology were observed between the two groups.
Conclusion:
Acceptable outcomes can be achieved even when the minimally invasive approach is considered the primary option for all patients who require liver resection. Minimally invasive tools are necessary for the modern practice of liver surgery; therefore, laparoscopic or robotic surgery should be included in the armamentarium of liver surgeons.
Insights
Minimally invasive liver resection (MILR) offers superior outcomes compared to open surgery, with reduced operative time, blood loss, and complications. This approach is crucial for modern liver surgery practices.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Minimally invasive liver resection (MILR) is increasingly adopted.
- Our center prioritizes MILR for all liver resections.
- This study evaluates outcomes and the shift from open surgery.
Purpose of the Study:
- To describe our experience with MILR.
- To emphasize the importance of minimally invasive approaches in liver surgery.
- To compare outcomes between open and MILR.
Main Methods:
- Retrospective review of 260 liver surgery patients.
- Comparison of surgical outcomes between open and MILR groups.
- Analysis of operative time, blood loss, complications, and hospital stay.
Main Results:
- 154 patients (68%) underwent MILR.
- MILR group showed shorter operative time, less blood loss, and lower Pringle maneuver rates.
- MILR was associated with lower major complication and bile leak rates.
- No differences in tumor size, lesion number, or liver pathology.
Conclusions:
- MILR can achieve acceptable outcomes as a primary option for liver resection.
- Minimally invasive techniques are essential for modern liver surgery.
- Laparoscopic and robotic surgery should be integral to liver surgeons' skills.
