Laparoscopic Liver Resection: Types, Classification and Current State
In this review, world experience of using laparoscopic surgical technology in the treatment of both benign and malignant liver tumors that require surgical correction has been analyzed.
Benefits of laparoscopic surgery in the surgical treatment of liver tumors compared to traditional open surgery were discussed. There is shown the evolution of laparoscopic surgery, from the simplest laparoscopic fenestration of small cysts to complicated laparoscopic liver hemihepatectomy that are now performed in leading surgical centers. This review examines the opinions of different surgical schools on the feasibility of using laparoscopic surgical technologies in benign and malignant tumors of the liver, and analyzes the main problems that hinder the development of laparoscopic liver surgery today. New technical aspects, such as Pringle maneuver in specific laparoscopic operations, were discussed. Also, different new technical devices, such as Bi Clamp, Habib electrosurgical instruments, were analyzed. Authors described big improvement in liver laparoscopic surgery after electric devices were implemented in clinical practice.
Laparoscopic liver surgery is a very popular type of surgery for today. Injury of abdominal wall after laparotomy by «Mercedes» type, high volume of intraoperative and postoperative complications, high level of mortality and morbidity are the main reasons of research in improving liver surgery. But liver anatomy and high risk of bleeding during surgery were the main factors of skepticism for laparoscopic technology in liver resection. Improvement in laparoscopic equipment, especially in electrocoagulation, gave new abilities for laparoscopy. Thus, many authors describe their initial experience in laparoscopic liver resection since 2000. As a first steps it was atypical marginal resection, mainly in segment II and III. But, with more personal experience and technical progress, many authors describe more complicated laparoscopic liver resection, such as left side hemihepatectomy. Minimal blood loss, low level of complications in early postoperative period, early rehabilitation, minimal time of hospital stay compared to open traditional liver resection were noted by all researches in this field. Main problem on this stage was technical complexity while performing this type of surgery. But many surgeons for today has an experience of performing right hemihepatectomy, and even laparoscopic resection of segment VII–VIII, which was a contraindications for any laparoscopic manipulations.
In world special literature approximately 60 % of all publications, regarding laparoscopic liver resection, were performed by Japans and Korean surgeons. Also, many publications came from USA and European countries. There are some nationwide researches, data from more than 10 centers were analyzed. Absolutely all researches prove great advantages for patients after laparoscopic liver resection. Many simultaneous operations by laparoscopic approach were described, for example laparoscopic liver resection and hemicolectomy, cholecystostomy, nefrectomy and many other combinations. In recent years, many articles regarding laparoscopic liver resection during liver transplantation were published. Authors pay much attention to maximal visualization of liver vessels during surgery, which gives better function for the graft after resection. Next step in minimally invasive massive liver resection was robotic assisted resections of the liver by using Da Vinci surgical platform. Most of publications regarding this type of liver resections came from American surgeons.
As a result, for today almost all surgeons describe many advantages of laparoscopic liver resection, and such therapy in many leading clinics is a method of choice for surgical treatment of patients with liver tumors and metastasis. But still some surgeons has a strong believes, that open surgery is a much better comparing to laparoscopic approach. This problem yet has to be investigated.
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