title: Laparoscopic liver resection: wedge resections to living donor hepatectomy, are we heading in the right direction?
abstract: 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 divided this 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.
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: P Thomas
authors.initials: PT
authors.lastname: Cherian
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Ashish Kumar
authors.initials: AK
authors.lastname: Mishra
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Palaniappen
authors.initials: P
authors.lastname: Kumar
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Vijayant Kumar
authors.initials: VK
authors.lastname: Sachan
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Bharathan
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Gadiyaram
authors.initials: G
authors.lastname: Srikanth
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Baiju
authors.initials: B
authors.lastname: Senadhipan
authors.affiliation: P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India.
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Rela
mesh_terms: D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cirrhosis; Hepatectomy; Hepatocellular; Laparoscopic; Liver; Living donor; Minimally invasive; Resection; Technique; Transplantation