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World Journal of Gastroenterology 2015年第22期21卷 7047-7051页

作者： Safi Dokmak Béatrice Aussilhou Fanjandrainy Rasoaherinomenjanahary Alain Sauvanet Marie-Pierre Vullierme Vinciane Rebours Philippe Lévy Department of hpb surgery and Liver Transplantation Beaujon Hospital Department of Radiology Beaujon Hospital Department of Gastroenterology Beaujon Hospital

Serous cystadenoma(SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC(12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers(ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after *** evaluation showed constant cyst *** were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min(70-150 min) with one *** post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last followup(13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

关键词： Pancreatic serous cystadenoma Laparoscopicfenestration Symptomatic

Typing of pancreatic cancer-associated fibroblasts identifies different subpopulations

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World Journal of Gastroenterology 2018年第41期24卷 4663-4678页

作者： Michael Friberg Bruun Nielsen Michael Bau Mortensen Sonke Detlefsen Department of Pathology Odense University HospitalDepartment of Clinical ResearchUniversity of Southern DenmarkOdense Pancreas Center(OPAC)Odense C 5000Denmark Department of surgery HPB SectionOdense University HospitalDepartment of Clinical ResearchUniversity of Southern DenmarkOdense Pancreas Center(OPAC)Odense C 5000Denmark

AIM To determine whether it is possible to identify different immune phenotypic subpopulations of cancer-associated fibroblasts (CAFs) in pancreatic cancer (PC). METHODS We defined four different stromal compartments in surgical specimens with PC: The juxtatumoural, peripheral, lobular and septal stroma. Tissue microarrays were produced containing all pre-defined PC compartments, and the expression of 37 fibroblast (FB) and 8 extracellular matrix (ECM) markers was evaluated by immunohistochemistry, immunofluorescence (IF), double-IF, and/or in situ hybridization. The compartment-specific mean labelling score was determined for each marker using a four-tiered scoring system. DOG1 gene expression was examined byquantitative reverse transcription PCR (qPCR). RESULTS CD10, CD271, cytoglobin, DOG1, miR-21, nestin, and tenascin C exhibited significant differences in expression profiles between the juxtatumoural and peripheral compartments. The expression of CD10, cytoglobin, DOG1, nestin, and miR-21 was moderate/strong in juxtatumoural CAFs (j-CAFs) and barely perceptible/weak in peripheral CAFs (p-CAFs). The upregulation of DOG1 gene expression in PC compared to normal pancreas was verified by qPCR. Tenascin C expression was strong in the juxtatumoural ECM and barely perceptible/weak in the peripheral ECM. CD271 expression was barely perceptible in j-CAFs but moderate in the other compartments. Galectin-1 was stronger expressed in j-CAFs vs septal fibroblasts, PDGFRβ, tissue transglutaminase 2, and hyaluronic acid were stronger expressed in lobular fibroblasts vs p-CAFs, and plectin-1 was stronger expressed in j-CAFs vs l-FBs. The expression of the remaining 33 markers did not differ significantly when related to the quantity of CAFs/FBs or the amount of ECM in the respective *** Different immune phenotypic CAF subpopulations can be identified in PC, using markers such as cytoglobin, CD271, and miR-21. Future studies should determine whether CAF subpo

关键词： Pancreatic cancer Tumour stroma Cancerassociated fibroblasts Extracellular matrix Subtyping Immunohistochemistry

Development and internal validation of the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score:is the patient suitable for Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)?

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Hepatobiliary surgery and Nutrition 2022年第1期11卷 52-66,I0007,I0008页

作者： Ivan Capobianco Karl J.Oldhafer Mohammed-Hossein Fard-Aghaie Ricardo Robles-Campos Roberto Brusadin Henrik Petrowsky Michael Linecker Arianeb Mehrabi Katrin Hoffmann Jun Li Asmus Heumann Roberto Hernandez-Alejandro Mauro Enrique Tun-Abraham Elio Jovine Matteo Serenari Bergthor Bjornsson Per Sandström Ruslan Alikhanov Mikhail Efanov Paolo Muiesan Andrea Schlegel Thomas M.van Gulik Pim B.Olthof Gregor Alexander Stavrou Lina Maria Serna-Higuita Alfred Königsrainer Silvio Nadalin Department of General Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany Department of General and Abdominal surgery Asklepios Hospital BarmbekHamburgGermany Department of surgery Virgen de la Arrixaca Clinic and University HospitalMurciaSpain Swiss hpb and Transplantation Center Department of SurgeryZurich University HospitalZurichSwitzerland Department of General Visceraland Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany General Visceral and Thoracic Surgery Department and ClinicHamburg-Eppendorf University Medical CenterHamburgGermany Division of Transplantation and Hepatobiliary surgery University of RochesterRochesterNYUSA Division of hpb surgery and Liver Transplantation Department of SurgeryLondon Health Sciences CentreLondonCanada General and Emergency surgery Unit Azienda Ospedaliero-Universitaria di BolognaMaggiore HospitalBolognaItaly General surgery and Transplantation Unit Azienda Ospedaliero-Universitaria di BolognaSant’Orsola-Malpighi HospitalBolognaItaly Department of surgery in Linköping and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden Department of Hepatopancreatobiliary surgery Moscow Clinical Scientific CenterMoscowRussia Liver Unit Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK Department of surgery Amsterdam UMC(Location AMC)University of AmsterdamAmsterdamThe Netherlands Department of General Abdominal and Thoracic SurgerySurgical OncologySaarbruecken General HospitalSaarbrueckenGermany Department of Clinical Epidemiology and Applied Biometry University of TübingenTübingenGermany

Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver *** study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality ***:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying ***:A total of 451 patients were *** was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for *** 1,000 cycles of bootstrapping the C statistic was *** accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of ***:Comorbidities play an important role in ALPPS and should be carefully considered when planning the *** assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.

关键词： Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS) comorbidity mortality prediction model patient selection

Ventilation after pancreaticoduodenectomy increases perioperative mortality: Identification of risk factors and their relevance in Germany that do not apply in England

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 379-388页

作者： Rieke-Sophie Homeyer Keith JRoberts Robert P Sutcliffe Alexander Kaltenborn Darius Mirza Zhi Qu Jurgen Klempnauer Harald Schrem Core Facility Quality Management Transplantation Integrated Research and Treatment Center Transplantation(IFB-Tx)Hannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany General Visceral and Transplant SurgeryHannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany Department of hpb surgery Queen Elizabeth Hospital BirminghamMindelsohn Way EdgbastonBirmingham B15 2GWUnited Kingdom Department of General Visceral and Transplant SurgeryMedical University GrazAuenbrugger Platz 58036 GrazAustria

Background:Pre-operative risk factors for post-operative ventilation and their influence on survival after pancreaticoduodenectomy for malignancy are ***:Totally 391 patients operated in Hannover,Germany were investigated with multivariable logistic regression and Cox regression modeling to identify independent risk factors for post-operative ventilation≥6 h,patient survival and 90-day *** 84 patients operated in Birmingham,United Kingdom were analyzed to assess the external relevance of ***:Longer operations,history of thrombosis,intra-operative blood transfusion,lower estimated glomerular filtration rates(eGFR)and higher values of the age at operation divided by the Horovitz Quotient independently increased the risk of post-operative ventilation≥6 h in German patients(n=108;27.6%)(P75 years,had a history of thrombosis,received blood transfusions,and had significantly worse lung function ***4 tumors were detected in 18 German patients(4.6%),but not in the English ***:Identified risk factors for post-operative ventilation are clinically relevant in Germany but not in England and may be used to lower mortality *** German and the English cohorts displayed significant differences in the approach to patient selection and early post-operative extubation.

关键词： Pancreatic cancer Cholangiocellular carcinoma Periampullary carcinoma Comorbidity Outcome

Liver transplantation for non-resectable colorectal metastases-an evolving paradigm in transplant oncology

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Hepatobiliary surgery and Nutrition 2023年第3期12卷 424-427页

作者： Christian Hobeika Markus Selzner Ajmera Transplant Centre Toronto General HospitalUniversity Health NetworkTorontoONCanada Department of hpb surgery and Liver Transplantation Beaujon HospitalAPHPClichyParis-CitéUniversityParisFrance UMR Inserm 1275 CAP Paris-Tech Lariboisière HospitalParisParis-CitéUniversityParisFrance Department of surgery University of TorontoTorontoONCanada

A better understanding of colorectal liver metastasis(CRLM)onco-genomics and the improvement of systemic treatments,including targeted and immune therapies,have shifted the paradigm of CRLM prognosis over the past two *** 40%of the patients with colorectal cancers are likely to develop CRLM[and 50%of them to be non-resectable(nCRLM)],current oncologic management allows for the identification of a subset of CRLM patients with controlled diseases likely to highly benefit from curative resections and,perhaps,liver transplantation(LT).Indeed,the Norwegian SECA I trial in 2013(1)triggered a growing interest in LT as a curative treatment for non-resectable colorectal liver metastasis(nCRLM).This strategy is supported by several pilot studies reporting up to 80%of 5-year estimated overall survival(OS)after LT for CRLM,in contrast to the poor results obtained in the early 80’s series.

关键词： Colorectal cancer liver metastasis transplant oncology guidlines liver transplantation(LT) organ shortage living donor

Impact of previous cyst-enterostomy on patients' outcome following resection of bile duct cysts

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World Journal of Gastrointestinal surgery 2016年第6期8卷 427-435页

作者： Mehdi Ouaissi Reza Kianmanesh Emilia Ragot Jacques Belghiti Pietro Majno Gennaro Nuzzo Remi Dubois Yann Revillon Daniel Cherqui Daniel Azoulay Christian Letoublon Frane is-Rene Pruvot Francois Paye Patrick Rat Karim Boudjema Adeline Roux Jean-Yves Mabrut Jean-François Gigot Department of General and Digestive surgery La Timone Hospital13009 MarseilleFrance Department of Digestive and Endocrine surgery Robert DebréHospital51090 ReimsFrance Department of hpb surgery Beaujon Hospital92110 ClichyFrance Department of Digestive surgery Geneva University Hospital1205 GenevaSwitzerland Department of hpb surgery Gemelli University Hospital00168 RomaItaly Department of Pediatric surgery Mother and Children Hospital69677 BronFrance Department of Pediatric Digestive surgery Necker Hospital75175 ParisFrance Department of Digestive and hpb surgery Paul Brousse Hospital94800 VillejuifFrance Department of Digestive and hpb surgery Henri Mondor Hospital94000 CreteilFrance Department of Digestive surgery Michallon Hospital38043 GrenobleFrance Department of Digestive surgery and Transplantation Claude Huriez Hospital59037 LilleFrance Department of Digestive surgery Saint Antoine Hospital75012 ParisFrance Department of Digestive surgery Dijon University Hospital21000 DijonFrance Department of hpb surgery Pontchaillou Hospital35033 RennesFrance Pôle Information Médicale Evaluation Recherche Unitéde Recherche Clinique69317 LyonFrance Department of Digestive surgery and Hepatic Transplantation La Croix-Rousse Hospital69317 LyonFrance Department of Abdominal surgery and Transplantation Division of Hepato-Biliary and Pancreatic surgery Cliniques Universitaires Saint-Luc 1200 BrusselsBelgium

AIM:To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts(BDC)***:A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical *** Todani subtypes I and IVb were *** imaging studies and operative and pathology reports underwent central *** with and without a previous history of cystenterostomy(CE)were ***:Among 243 patients with Todani types I and IVb BDC,16 had undergone previous CE(6.5%).Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis(75%vs 22.9%,P<0.0001),had more complicated presentations(75%vs 40.5%,P=0.007),and were more likely to have synchronous biliary cancer(31.3%vs 6.2%,P=0.004)than patients without a prior *** morbidity(75%vs 33.5%;P<0.0008),severe complications(43.8%vs 11.9%;P=0.0026)and reoperation rates(37.5%vs 8.8%;P=0.0032)were also significantly greater in patients with previous CE,and their Mayo Risk Score,during a median follow-up of 37.5 mo(range:4-372 mo)indicated significantly more patients with fair and poor results(46.1%vs 15.6%;P=0.0136).CONCLUSION:This is the large series to show that previous CE is associated with poorer short-and longterm results after Todani types I and IVb BDC resection.

关键词： Bile duct cyst Congenital Biliary disease Cyst-enterostomy Long-term outcome

Post-transplant biliary complications using liver grafts from deceased donors older than 70 years:Retrospective case-control study

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1615-1628页

作者： Carlos Jimenez-Romero Iago Justo-Alonso Pilar del Pozo-Elso Alberto Marcacuzco-Quinto Cristina Martín-Arriscado-Arroba Alejandro Manrique-Municio Jorge Calvo-Pulido Alvaro García-Sesma Ricardo San Román Oscar Caso-Maestro Unit of hpb surgery and Abdominal Organs Transplantation `12 de Octubre´University HospitalMadrid 28041Spain Clinical Research Unit(I+12) `12 de Octubre´University HospitalMadrid 28041Spain Department of Radiology `12 de Octubre´University HospitalMadrid 28041Spain

BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older *** To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 *** Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 *** excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both *** Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation *** incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both *** were no significant differences in the patient and graft survival between the ***,only three deaths were attributed to *** female donors were protective factors for BC,donor cardiac arrest was a risk *** The incidence of BC was relatively low on using liver grafts>70 *** could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.

关键词： Older liver Liver transplant Biliary complications Biliary strictures Septuagenarian donors Octogenarian donors

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

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World Journal of Gastroenterology 2017年第13期23卷 2376-2384页

作者： Amilcare Parisi Daniel Reim Felice Borghi Ninh T Nguyen Feng Qi Andrea Coratti Fabio Cianchi Maurizio Cesari Francesca Bazzocchi Orhan Alimoglu Johan Gagnière Graziano Pernazza Simone D'Imporzano Yan-Bing Zhou Juan-Santiago Azagra Olivier Facy Steven T Brower Zhi-Wei Jiang Lu Zang Arda Isik Alessandro Gemini Stefano Trastulli Alexander Novotny Alessandra Marano Tong Liu Mario Annecchiarico Benedetta Badii Giacomo Arcuri Andrea Avanzolini Metin Leblebici Denis Pezet Shou-Gen Cao Martine Goergen Shu Zhang Giorgio Palazzini Vito D'Andrea Jacopo Desiderio Department of Digestive surgery St.Mary's HospitalUniversity of Perugia Klinik und Poliklinik fuer Chirurgie Klinikum Rechts der IsarTechnical University Munich Department of surgery General and Oncologic Surgery UnitSanta Croce e Carle Hospital Department of surgery Division of Gastrointestinal SurgeryUniversity of CaliforniaIrvine Medical Center Gastrointestinal surgery Tianjin Medical University General Hospital Division of Oncological and Robotic surgery Department of OncologyCareggi University Hospital Unit of general and endocrine surgery Center of oncologic minimally invasive surgery(COMIS)Careggi University Hospital Department of General surgery Hospital of Cittàdi CastelloUSL1 Umbria Department of General surgery Division of GeneralGastroenterologic and Minimally Invasive SurgeryG.B.Morgagni Hospital Department of General surgery School of MedicineIstanbul Medeniyet University Department of Digestive and Hepatobiliary surgery Estaing University Hospital Department of surgery Robotic General Surgery UnitSan Giovanni Addolorata Hospital Esophageal surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal DiseaseMedical University of Pisa Department of General surgery The Affiliated Hospital of Qingdao University Unitédes Maladies de l'Appareil Digestif et Endocrine Centre Hospitalier de Luxembourg Service de Chirurgie Digestive et Cancérologique CHU Bocage Department of Surgical Oncology and hpb surgery Englewood Hospital and Medical Center Department of General surgery Jinling HospitalMedical SchoolNanjing University Department of surgery Ruijin HospitalShanghai Jiaotong UniversitySchool of Medicine Department of General surgery Erzincan UniversitySchool of Medicine Department of Surgical Science “La Sapienza”University Department of Digestive surgery St.Mary's Hospital of Terni-University of Perugia

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological *** This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also *** The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recov

关键词： Gastric cancer Gastrectomy Minimally invasive surgery Robotic Robot-assisted Laparoscopy

Venous resection at pancreaticoduodenectomy can be safely performed in the presence of jaundice

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 488-491页

作者： Rupaly Pande James Hodson Ravi Marudanayagam Darius Mirza John Isaac Keith J Roberts hpb surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Translational Medicine University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Immunology and Immunotherapy University of BirminghamBirmingham B152THUK

Venous resection at pancreaticoduodenectomy(PD)has established itself as a viable treatment for borderline resectable cancer,with equivalent survival to those patients undergoing PD for cancer without venous resection[1].Thus surgery for these patients is clearly desirable,when possible,compared to palliative ***,there is concern and debate about the safety of venous resection at PD[2].There is a need to improve patient pathways,outcome and experience[3].To this end,in patients who present with jaundice,it is clear that surgery without preoperative biliary drainage(PBD)reduces complications[4].In 2015,our team introduced a‘fast track’program to routinely perform PD in the presence of jaundice[5].This change of practice has become routine,with most patients now undergoing surgery without *** is,however,unclear whether portal vein(PV)resection+PD is safe in the setting of *** aim of this study,therefore,was to compare outcomes and complications between patients with or without jaundice undergoing PD with associated resection of the superior mesenteric vein(SMV)and/or PV.

关键词： jaundice resection routine

Difficult procedures,better outcomes

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Hepatobiliary surgery and Nutrition 2023年第4期12卷 634-636页

作者： Davit L.Aghayan Airazat M.Kazaryan Asmund Avdem Fretland Bjorn Edwin The Intervention Centre Oslo University Hospital-RikshospitaletOsloNorway Department of surgery N1 Yerevan State Medical University after M.HeratsiYerevanArmenia Institute of Clinical Medicine Medical FacultyUniversity of OsloOsloNorway Department of Gastrointestinal and Pediatric surgery Oslo University Hospital-UllevålOsloNorway Department of surgery Østfold Hospital TrustGrålumNorway Department of Faculty surgery N 2 I.M.Sechenov First Moscow State Medical UniversityMoscowRussia Department of surgery Fonna Hospital TrustOddaNorway Department of hpb surgery Oslo University Hospital-RikshospitaletOsloNorway

Despite the initial skepticism and challenges,minimally invasive liver surgery especially laparoscopic liver resections(LLR),has become a first-choice surgical treatment for various liver tumors in many specialized centers worldwide(1-3).It is a safe alternative to open surgery thanks to advantages such as reduced blood loss and complication rates,shorter hospital stay,and better quality of life(4-7).However,laparoscopy requires relatively long learning,and complex procedures are limited to high-volume expert centers(8).

关键词： Liver resection laparoscopic liver surgery minimally invasive liver surgery complex procedures