title: Laparoscopic liver resection: Toward a truly minimally invasive approach.
abstract: In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomy in case of intrahepatic recurrence. Parenchyma-sparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchyma-sparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach.
authors: Satoshi Ogiso, Etsuro Hatano, Shinji Uemoto, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
authors: Satoshi
authors: S
authors: Ogiso
authors: Satoshi Ogiso, Etsuro Hatano, Shinji Uemoto, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
authors: Etsuro
authors: E
authors: Hatano
authors: Satoshi Ogiso, Etsuro Hatano, Shinji Uemoto, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
authors: Takeo
authors: T
authors: Nomi
authors: Satoshi Ogiso, Etsuro Hatano, Shinji Uemoto, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
authors: Shinji
authors: S
authors: Uemoto
keywords: Colorectal carcinoma; Hepatectomy; Hepatocellular carcinoma; Laparoscopic surgery; Laparoscopy; Liver lesion; Liver metastasis; Liver resection; Minimally-invasive; Parenchyma-sparing