title: Laparoscopy-Specific Surgical Concepts for Hepatectomy Based on the Laparoscopic Caudal View: A Key to Reboot Surgeons' Minds.
abstract: BACKGROUND
  Despite diffusion of laparoscopic hepatectomy, the acquisition of necessary skills is not easy for open liver surgeons. Concepts and techniques have totally changed in laparoscopic hepatectomy compared with open hepatectomy, which is an underlying cause of a technical hurdle in laparoscopic hepatectomy. This study aimed to illustrate laparoscopy-specific concepts and techniques for hepatectomy.
  
  
  METHODS
  Video footages of laparoscopic and open hepatectomies stored in the Institut Mutualiste Montsouris and Kyoto University were reviewed to define the differences in surgical view, surgical concept, and technical details, using left lateral sectionectomy (LLS) and right hepatectomy (RH) as representative examples.
  
  
  RESULTS
  By comparison with open LLS and RH, laparoscopy-specific procedures were identified with regard to surgical view, parenchymal transection, available landmarks, and vascular dissection. By laparoscopy, the surgical field was constantly viewed and accessed from the caudal side to the cranial side. Similarly, the parenchyma was divided, and intrahepatic vessels were dissected in the same direction. Laparoscopy-specific landmarks were identified for both LLS and RH, behind the liver.
  
  
  CONCLUSIONS
  The concepts and techniques in laparoscopic hepatectomy are totally different from those of open hepatectomy because of the different surgical views. Understanding the laparoscopy-specific concepts and techniques would facilitate safe and efficient execution of laparoscopic hepatectomy.
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France. oggy_so@ybb.ne.jp.|Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. oggy_so@ybb.ne.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogiso
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.|Department of Surgery, Nara Medical University, Nara, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.|Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Araki
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.|Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France. Brice.Gayet@imm.fr.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D013502:General Surgery / Q000193:education*; D006498:Hepatectomy / Q000379:methods* / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008113:Liver Neoplasms / Q000601:surgery*