Approaches to laparoscopic anatomic liver resection: Does one size fit all?

Various approaches to laparoscopic anatomic liver resection have been described. In this paper, the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava. While many liver surgeons partially adopt this elements of this method, few employ it to the full extent outlined here. Maintaining low central venous pressure during anesthesia is critical to this approach, as demonstrated by the operative images showing collapsed hepatic veins. This technique is particularly advantageous when the patient's body mass index is low, the tumor is small (or large but deeply embedded within the liver parenchyma), and the overlying liver tissue is not excessively bulky or heavy. Nonetheless, following the conventional course along the Glissonean pedicle can be beneficial. The authors demonstrate notable skill in completing these procedures laparoscopically. However, concerns over margin positivity and tumor recurrence remain, and follow up studies are needed to further validate the approach.