Landmarks to identify segmental borders of the liver: A review prepared for PAM‐HBP expert consensus meeting 2021

Abstract

Background:In preparation for the upcoming consensus meeting in Tokyo in 2021, this systematic review aimed to analyze the current available evidence regarding surgical anatomy of the liver, focusing on useful landmarks, strategies and technical tools to perform precise anatomic liver resection (ALR). Methods: A systematic review was conducted on MEDLINE/PubMed for English articles and on Ichushi database for Japanese articles until September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 3169 manuscripts were obtained, 1993 in English and 1176 in Japanese literature. Subsequently, 63 English and 20 Japanese articles were selected and reviewed. The quality assessment of comparative series and case series was revealed to be usually low; only six articles were qualified as high quality. Forty-two articles focused on analyzing intersegmental/sectional planes and their relationship

Minimally invasive anatomic liver resection: Results of a survey of world experts

“…Therefore, we firstly performed systematic reviews to obtain existing evidence. [2][3][4] Next, we sought opinions from the selected experts throughout the world and explored a reasonable method for safely carrying out MIALR. In a recently published report of a survey regarding MILR, 5 many of the respondents were inexperienced surgeons.…”

“…11 In another systematic review conducted before PAM-HBP Surgery, helpful landmarks included the root of the major hepatic vein, a demarcation line on the surface, intersegmental veins, extrahepatic Glissonean pedicles, and the others. 4 In anatomic resection, it is considered that the liver should be dissected along with the appropriate IP by connecting them. In response to a questionnaire about the techniques for identifying IP, the three most valuable techniques in both open and laparoscopic surgery were the creation of a demarcation line, the indocyanine green (ICG) negative staining method, and intraoperative ultrasound.…”

Expert Consensus Guidelines: How to safely perform minimally invasive anatomic liver resection

“…The main limitation of this manuscript is that the recommendations are not based on high-level evidence. Although we have already reported systematic reviews, [2][3][4] there were no prospective randomized controlled trials in the literature reviews. Instead, most of the literature was categorized as "expert opinions" and "case series", which were evaluated as low-level evidence.…”

“…The detailed results and the process of this literature review have been previously published elsewhere. [2][3][4] An expert survey was simultaneously performed to collect experts' opinions. The survey group consisted of experts from Spain, France, Italy, and Japan, who identified survey questions regarding MIALR anatomy and approach topics which were then approved by the steering committee.…”

The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery

“…Indeed, it guarantees the identification of the intersegmental planes and the borders of the resection not only on the surface but also in the deep liver, removing the whole tumor-bearing area and leaving a well-vascularized parenchyma. In the era of minimally invasive liver surgery, ICG fluorescence helps identify liver segments boundaries and localize tumors, even in cirrhotic livers [ 42 ]. This technology, may help overcome the limitations of LLR (lack of tactile sensation, challenges in ultrasound) for both anatomical and non-anatomical resections.…”