title: Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques.
abstract: OBJECTIVE
  This review assesses the current status of laparoscopic liver resection.
  
  
  BACKGROUND
  The trend in laparoscopic liver resection has been moving from limited resections toward major hepatectomy. The surgical techniques for laparoscopic major hepatectomy include pure laparoscopic, hand-assisted laparoscopic, and laparoscopy-assisted methods. We performed a literature search and systematic review to assess the current status of laparoscopic major hepatectomy.
  
  
  METHODS
  Our literature review was conducted in Medline using the keywords "laparoscopy" or "laparoscopic" combined with "liver resection" or "hepatectomy." Articles written in English containing more than 10 cases of laparoscopic major hepatectomy were selected.
  
  
  CONCLUSIONS
  Twenty-nine articles were selected for this review. The laparoscopic major hepatectomies achieved similar patient and economic outcomes compared with open liver resections in selected (noncirrhotic) patients. Surgeon experience with the techniques affected the results; thus, a learning period is mandatory. Of these 3 techniques, the pure laparoscopic method is suitable for experienced surgeons to achieve better cosmetic outcomes, whereas the hand-assisted laparoscopic method was associated with better perioperative outcomes; the laparoscopy-assisted method is used by surgeons for unique resections such as resection of cirrhotic livers, laparoscopic resection of tumors in unfavorable locations, and living donor hepatectomies. In addition, the laparoscopic major hepatectomy-specific, long-term oncologic outcomes remain to be addressed in future publications.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Uchimaru, Morioka, Iwate, Japan.
authors.forename: Niang-Cheng
authors.initials: NC
authors.lastname: Lin
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery; D004618:Embolism, Air / Q000209:etiology; D058733:Hand-Assisted Laparoscopy; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D019520:Living Donors; D012371:Robotics; D016896:Treatment Outcome