Over the last two decades, laparoscopic surgery has been adopted in various surgical fields. Its advantages of reduced blood loss, reduced postoperative morbidity, shorter hospital stay, and excellent cosmetic outcome compared with conventional open surgery are well validated. In comparison with other abdominal organs, laparoscopic hepatectomy has developed relatively slowly due to the potential for massive bleeding, technical difficulties and a protracted learning curve. Furthermore, applications to liver graft procurement in living donor liver transplantation (LDLT) have been delayed significantly due to concerns about donor safety, graft outcome and the need for expertise in both laparoscopic liver surgery and LDLT. Now, laparoscopic left lateral sectionectomy in adult-to-pediatric LDLT is considered the standard of care in some experienced centers. Currently, the shift in application has been towards left lobe and right lobe graft procurement in adult LDLT from left lateral section in pediatric LDLT. However, the number of cases is too small to validate the safety and reproducibility. The most important concern in LDLT is donor safety. Even though a few studies reported the technical feasibility and comparable outcomes to conventional open surgery, careful validating through larger sample sized studies is needed to achieve standardization and wide application.

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Background: Laparoscopic living-donor hepatectomy for transplantation has been established well over the last decade. This study aimed to assess its safety and feasibility in pediatric living-donor liver transplantation (LDLT) by comparing the surgical and longterm survival outcomes on both the donor and recipient sides between open and laparoscopic groups. Methods: The medical records of 100 patients (≤17 years old) who underwent ABOcompatible LDLT using a left lateral liver graft between May 2008 and June 2016 were analyzed. Thirty-one donors who underwent pure laparoscopic hepatectomy and their corresponding recipients were included in the study. Sixty-nine patients who underwent open living-donor hepatectomy during the same period were included as a comparison group. To overcome bias from the different distributions of covariables among the patients in the two study groups, a 1:1 propensity score matching analysis was performed. Results: The mean follow-up periods were 92.9 and 92.7 months in the open and laparoscopic groups, respectively. The mean postoperative hospital stay of the donors was significantly shorter in the laparoscopic group (8.1 days) than in the open group (10.6 days; p<0.001). Overall, the surgical complications in the donors and overall survival rate of recipients did not differ between the groups. Conclusion: Our data suggests that the laparoscopic environment was not associated with long-term graft survival during pediatric LDLT. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation.

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.

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Hepatocellular carcinoma (HCC) accounts for up to 90% of all primary hepatic malignancies and is the fifth most common malignancy and fourth leading cause of cancer-related death worldwide. 1,2 Treatment choices for patients with HCC are affected by the tumor stage, degree of liver dysfunction, and patient comorbidities.Liver transplantation (LT), liver resection (LR), and radiofrequency ablation are common curative treatment options, although LT is considered the best treatment strategy, as it removes the tumor and cures the underlying liver disease. 3,4 However, because of the shortage of available donor grafts leading to dropout or waiting-time mortality, LR is considered a reasonable first-line locoregional treatment modality in selected transplantation-eligible patients. Unfortunately,

These results suggest that BIS monitoring is a non-invasive, simple, easy-to-interpret method, which is useful in assessing peritransplant state of consciousness. BIS monitoring may therefore be a useful tool during peritransplant intensive care for patients with FHF showing hepatic encephalopathy.

Although pancreatoduodenectomy is the standard treatment for periampullary neoplasms, limited pancreas-preserving resections are sometimes performed. This report describes a carcinoid tumor of the ampulla of Vater for which pancreatoduodenectomy was not feasible because of diffuse cavernous transformation of the portal vein (PV) secondary to main PVobliteration of unknown cause. We performed retroduodenal resection of the ampullary carcinoid with total preservation of the pancreas. The duodenal wall defect was primarily repaired, and the pancreatic and bile ducts were separately reconstructed using Roux-en-Y pancreaticojejunostomy and choledochojejunostomy. The patient recovered uneventfully and is currently progressing well at 10 months postoperatively, with no tumor recurrence or complications. The surgical procedures are described, and the literature pertaining to this limited surgery is reviewed.