Evolution and revolution of laparoscopic liver resection in Japan

Abstract

Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

Current topics in liver surgery

“…Recently, consensus guidelines to determine suitable tumor location and optimal procedure for laparoscopic liver resection have been developed. A pre‐registration system has also been available since 2015 to ensure safety and to maintain the quality of laparoscopic liver resection …”

Useful maneuvers for precise laparoscopic liver resection

“…Several types of positions in LLR have been reported. According to reports, the feasibility of different positions for specific operation depends on the location of the resection, but there is still no consensus on the best position for LLR . Some studies recommended the conventional supine position, with or without the patient's legs spread, or the low lithotomy position for resection of the left hemi‐liver or right anterior part of the liver .…”

The role of robotics in liver surgery

“…5,6 Evermore, laparoscopic liver surgery expanded to include hemi-hepatectomy, sectionectomy, segmentectomy, and recently, parenchymal preserving and modified anatomical resections, mirroring the technological, as well as, the conceptual advances in liver surgery. 7,8…”