Abstract
Although laparoscopic liver resection (LLR) has become recognized as the standard treatment worldwide, laparoscopic major hepatectomy (LMH) has yet to become widespread. LMH was first defined as resection of 3 or more segments or the difficult posterosuperior segments (4a, 7, 8) in 2008. Although the definition is still under debate and is not clearly defined, several studies reported that LMH was associated with less blood loss, shorter hospital stays and fewer complications compared with open surgery. According to a nationwide survey of Japanese National Clinical Database, advanced LLR increased from 3.3% of all resections in 2011 to 10.8% in 2017, with its mortality 3.6% in 2011, and 1.0% in 2017. The IWATE criteria can be used to predict the difficulty of LLR from preoperative variables and to appropriately select patients according to the surgeons’ skill level. The learning curve for LMH has been discussed, but conclusive number of cases for the mastery of LMH cannot be decided with variety of studies. Since laparoscopic parenchymal-sparing anatomical liver hepatectomy (Lap-PSAH = segmentectomies and sub-segmentectomies) shares some surgical techniques with LMH, it may help shorten the learning curve of LMH. In conclusion, LMH still remains technically demanding, but it has been gradually developed with the improvement of surgical techniques and the careful expansion of indications.
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Mishima, K., Wakabayashi, G., Igarashi, K., Ozaki, T. (2022). Laparoscopic Major Hepatectomy and Parenchymal-Sparing Anatomical Hepatectomy. In: Makuuchi, M., et al. The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-19-0063-1_34
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