title: Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization.
abstract: BACKGROUND
  Although laparoscopic colorectal or gastric surgery has become widely accepted as a superior alternative to conventional open surgery, the surgical management of hepato-biliary-pancreatic disease has traditionally involved open surgery. Recently, many reports have described laparoscopic partial liver resection, lateral segmentectomy, and distal pancreatectomy. However, laparoscopic major hepato-biliary-pancreatic surgery, such as hepatic lobectomy and pancreaticoduodenectomy, has not been widely developed because of technical difficulties.
  
  
  METHODS
  We describe our experience with laparoscopic major hepato-biliary-pancreatic surgery, including right hepatectomy using hilar Glissonean pedicle transaction, and pylorus-preserving pancreaticoduodenectomy.
  
  
  CONCLUSIONS
  Although our experience is limited, and randomized study is necessary to elucidate the appropriate indications for and effects of the present procedures, we believe that laparoscopic major hepato-biliary-pancreatic surgery can be feasible, safe, and effective in highly selected patients, and that it will be one of the standard therapeutic options for carefully selected patients with hepato-biliary-pancreatic disease.
authors.affiliation: Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chuouku, Chiba, 260-8717, Japan. acho@chiba-cc.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Cho
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Matsuo
authors.initials: M
authors.lastname: Nagata
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takiguchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Osamu
authors.initials: O
authors.lastname: Kainuma
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Souda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gunji
authors.forename: Akinari
authors.initials: A
authors.lastname: Miyazaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ikeda
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tohma
authors.forename: Ikuko
authors.initials: I
authors.lastname: Matsumoto
mesh_terms: D001652:Bile Ducts / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D008099:Liver / Q000601:surgery; D008488:Medical Illustration; D010179:Pancreas / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*