Reducing invasiveness in liver surgery-where is the limit?

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Surgical Technology

Background:

• Liver surgery has seen significant progress in the last two decades.
• Key advancements include refined surgical techniques like the extraglissonean approach and technology such as laparoscopy and robotics.

Purpose of the Study:

• To comment on the article by Wang et al. regarding laparoscopic liver resections.
• To discuss the extraglissonean approach and its application in segmental liver resections.
• To explore past, present, and future perspectives of the extraglissonean approach in laparoscopic liver surgery.

Main Methods:

• Review and commentary on a published article detailing laparoscopic segmentectomy using the extraglissonean approach.
• Analysis of segmental resections of all eight liver segments.
• Discussion of defined "hilar gates" for safe liver resection via Glissonean pedicle ligation followed by parenchymal resection.

Main Results:

• The article by Wang et al. presents laparoscopic segmentectomy using the extraglissonean approach.
• The novelty lies in the description of segmental resections for all eight liver segments.
• The extraglissonean approach, previously described mainly for hepatectomies or lateral sectionectomies, is applied to comprehensive segmental resections.

Conclusions:

• The extraglissonean approach combined with laparoscopy represents a significant advancement in liver surgery.
• The ability to perform segmental resections of all eight liver segments enhances the utility of this technique.
• This commentary provides valuable insights into the current and future role of the extraglissonean approach in minimally invasive liver surgery.