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      First quarter century of laparoscopic liver resection

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          Abstract

          The beginnings of laparoscopic liver resection (LLR) were at the start of the 1990s, with the initial reports being published in 1991 and 1992. These were followed by reports of left lateral sectionectomy in 1996. In the years following, the procedures of LLR were expanded to hemi-hepatectomy, sectionectomy, segmentectomy and partial resection of posterosuperior segments, as well as the parenchymal preserving limited anatomical resection and modified anatomical (extended and/or combining limited) resection procedures. This expanded range of LLR procedures, mimicking the expansion of open liver resection in the past, was related to advances in both technology (instrumentation) and technical skill with conceptual changes. During this period of remarkable development, two international consensus conferences were held (2008 in Louisville, KY, United States, and 2014 in Morioka, Japan), providing up-to-date summarizations of the status and perspective of LLR. The advantages of LLR have become clear, and include reduced intraoperative bleeding, shorter hospital stay, and - especially for cirrhotic patients-lower incidence of complications ( e.g., postoperative ascites and liver failure). In this paper, we review and discuss the developments of LLR in operative procedures (extent and style of liver resections) during the first quarter century since its inception, from the aspect of relationships with technological/technical developments with conceptual changes.

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          Most cited references60

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          Laparoscopic excision of benign liver lesions.

          Increasing sophistication in laparoscopic instrumentation and techniques has led to an ever-expanding list of surgical indications that are no longer exclusive to gynecology. This report describes our experience with three women who had benign lesions of the liver edge found incidentally during laparoscopic surgery for gynecologic symptoms. The first women was managed traditionally with subsequent exploratory laparotomy; she developed ileus postoperatively and required a 5-day hospital stay. The other two were managed laparoscopically without incident. Each was hospitalized less than 24 hours. All three liver lesions proved benign on histologic examination. Although not all liver lesions can or should be excised laparoscopically, selected superficial neoplasms can be managed expediently by a laparoscopic approach.
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            Evaluation of 300 minimally invasive liver resections at a single institution: less is more.

            We present the largest, most comprehensive, single center experience to date of minimally invasive liver resection (MILR). Despite anecdotal reports of MILR, few large single center reports have examined these procedures by comparing them to their open counterparts. Three hundred MILR were performed between July 2001 and November 2006 at our center for both benign and malignant conditions. These included 241 pure laparoscopic, 32 hand-assisted laparoscopic, and 27 laparoscopy-assisted open (hybrid) resections.These MILR were compared with 100 contemporaneous, cohort-matched open resections. MILR included segmentectomies (110), bisegmentectomies (63), left hepatectomies (47), right hepatectomies (64), extended right hepatectomies (8), and caudate lobe (8) resections. Benign etiologies encompassed cysts (70), hemangiomata (37), focal nodular hyperplasia (FNH) (23), adenomata (47), and 20 live donor right lobectomies. Malignant etiologies included primary (43) and metastatic (60) tumors. Hepatic fibrosis/cirrhosis was present in 25 of 103 patients with malignant diseases (24%). There was high data consistency within the 3 types of MILR. MILR compared favorably with standard open techniques: operative times (99 vs. 182 minutes), blood loss (102 vs. 325 ml), transfusion requirement (2 of 300 vs. 8 of 100), length of stay (1.9 vs. 5.4 days), overall operative complications (9.3% vs. 22%), and local malignancy recurrence (2% vs. 3%). No port-site recurrences occurred. Conversion from laparoscopic to hand-assisted laparoscopic resection occurred in 20 patients (6%), with no conversions to open. No hand-assisted procedures were converted to open, but 2 laparoscopy-assisted (7%) were converted to open. Our data show that MILR outcomes compare favorably with those of the open standard technique. Our experience suggests that MILR of varying magnitudes is safe and effective for both benign and malignant conditions.
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              Laparoscopic liver resections: a feasibility study in 30 patients.

              To assess the feasibility and safety of laparoscopic liver resections. The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.
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                Author and article information

                Journal
                World J Gastroenterol
                World J. Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                28 May 2017
                28 May 2017
                : 23
                : 20
                : 3581-3588
                Affiliations
                Zenichi Morise, Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
                Go Wakabayashi, Department of Surgery, Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo, 362-8588 Saitama, Japan
                Author notes

                Author contributions: Morise Z and Wakabayashi G cooperated to collect the data and write this paper.

                Correspondence to: Zenichi Morise, MD, PhD, FACS, AGAF, Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukakecho, Toyoake, Aichi 470-1192, Japan. zmorise@ 123456fujita-hu.ac.jp

                Telephone: +81-562-939246 Fax: +81-562-935125

                Article
                jWJG.v23.i20.pg3581
                10.3748/wjg.v23.i20.3581
                5449415
                28611511
                41b46214-9f69-473c-8526-ce4c1fc1a893
                ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.

                Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 25 January 2017
                : 4 March 2017
                : 21 April 2017
                Categories
                Review

                hepatectomy,laparoscopic surgery,liver cancer,history,technology,technique,concept,approach,posture,simulation

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