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Laparoscopic liver resection:Wedge resections to living donor hepatectomy, are we heading in the right direction?

World Journal of Gastroenterology 2014年第37期20卷 13369-13381页

作者： P Thomas Cherian Ashish kumar Mishra palaniappen kumar Vijayant kumar Sachan Anand Bharathan Gadiyaram Srikanth Baiju Senadhipan Mohamad S Rela Department of HPB Surgery and Liver Transplantation Global Hospital Department of Gastro-intestinal Surgery BGS-Global Hospital Department of Gastro-intestinal Surgery SUT-Royal Hospital

Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.

关键词： Liver Laparoscopic Transplantation Resection Living donor Minimally invasive Technique Hepatocellular Hepatectomy Cirrhosis

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