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Sasidhar Reddy 10.5005/jp-journals-10033-1246
RevieW aRticLe

Laparoscopic Liver Resection: Current Status

and Techniques

Sasidhar Reddy

ABSTRACT the risk of air embolism. For malignant tumors, many
Laparoscopy has forever changed the landscape of surgery. expressed concerns about compromising oncological
1,2
Although hepatobiliary surgery remained the last bastion of clearance and tumor seeding in the peritoneal cavity.
‘maximal invasiveness,’ recently there has been a rise in the Despite these difficulties, instruments have improved
implementation of laparoscopy for complex liver operations. and surgical techniques have been refined to ensure
Liver surgeons have been slow to adopt the laparoscopic
technique for liver resections. This new approach has offered that laparoscopic liver resection is not only feasible and
the patient an alternative to the traditional bilateral subcostal safe, but also beneficial in terms of blood loss, length of
incision, and thereby tendered the marked benefits of limited hospital stay, and severity of wound pain. More than
incisions inherent to minimally invasive surgery. a thousand laparoscopic liver resections have been
As efficiency pressures continue to rise, the laparoscopic 3
approach for liver resection will likely be further embraced. To performed worldwide since 1992, after Gagner et al
this end, we surmise that the hybrid technique will gain favor, as performed the first nonanatomical resection of a liver
it more closely assimilates the skills that hepatobiliary surgeons tumor. Although most of these involved resections of
already possess. only one or two liver segments, major hepatectomies
4-7
Moreover, this technique offers the most palatable setting 8-10
of safety with the use of the hand for liver mobilization and have also been achieved laparoscopically. While some
prompt control of bleeding vasculature. attempted the relatively straightforward left lateral seg-
Liver surgery, although initially late to embrace laparoscopy, mentectomy laparoscopically, it was not until the advent
is now gaining momentum in this paradigm shift. The advent of of the hand-assisted technique that formal liver resection
innovative tools that mirror what is used conventionally have
facilitated this transition. became feasible for many hepatobiliary surgeons. This
divergence from the purely laparoscopic instrumentation
Keywords: Hybrid technique, Laparoscopic liver resection,
Laparoscopy. of the liver had many distinct advantages. Practically, the
hand is the most useful retractor, offering expedient con-
How to cite this article: Reddy S. Laparoscopic Liver Resection:
Current Status and Techniques. World J Lap Surg 2015;8(2):48-51. formational change and unmatched haptic feedback. As
such, intracorporeal hand insertion during laparoscopic
Source of support: Nil resection gives the surgeon enhanced tactile stabilization
Conflict of interest: None of the liver, allowing for more precise mobilization and
dissection of the target lobe. In addition, the hand port
inTRoduCTion serves as a retrieval site for the surgical specimen. This

Laparoscopy has forever changed the landscape of sur- new approach has offered the patient an alternative to
gery. Although hepatobiliary surgery remained the last the traditional bilateral subcostal incision, and thereby
bastion of ‘maximal invasiveness,’ recently there has been tendered the marked benefits of limited incisions inherent
a rise in the implementation of laparoscopy for complex to minimally invasive surgery. This laparoscopic advance
liver operations. Liver surgeons have been slow to adopt has extended into all forays of surgery with an ensuing
the laparoscopic technique for liver resections. decrease in incision size, which translates into less pain
Understandably, they are concerned about the control for the patient. With less pain comes earlier mobility,
of bleeding, difficulty in retraction and exposure, and which results in decreased morbidity and reduced length
of stay. Secondarily, direct costs may be reduced with the
use of laparoscopic techniques as a result of the earlier
Senior Registrar hospital discharge.
Department of Surgical Gastroenterology and Liver Heretofore laparoscopic hepatic resection has seemed
Transplantation, Sir Ganga Ram Hospital, New Delhi, India far afield, but the subsequent innovation has shifted the
Corresponding Author: Sasidhar Reddy, Senior Registrar paradigm. To this end, laparoscopy as applied to hepatic
Department of Surgical Gastroenterology and Liver Trans- surgery is germane to discussions of ‘best practices’ and
plantation, Sir Ganga Ram Hospital, New Delhi, India, Phone: offers a technical approach that should be considered for
+917838046417, e-mail: drshashi2708@gmail.com
many patients with liver pathology.
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