title: Comprehensive application of modern technologies in precise liver resection.
abstract: BACKGROUND
  Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection.
  
  
  METHODS
  PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment.
  
  
  RESULTS
  The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible.
  
  
  CONCLUSIONS
  Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large randomized trials are needed to evaluate the usefulness of these technologies in patients with hepatocellular carcinoma who have undergone precise liver resection.
authors.affiliation: Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China.
authors.forename: Nian-Song
authors.initials: NS
authors.lastname: Qian
authors.forename: Yong-Hui
authors.initials: YH
authors.lastname: Liao
authors.forename: Shou-Wang
authors.initials: SW
authors.lastname: Cai
authors.forename: Vikram
authors.initials: V
authors.lastname: Raut
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome