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Systematic review of the feasibility and future of laparoscopic liver resection for difficult lesions

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Abstract

Laparoscopic liver resection (LLR) is now performed widely, but is difficult to accomplish in some anatomical locations, such as the posterosuperior segments (S7 and S8) and caudate lobe (S1). An international survey revealed that lesions in these locations are less frequently indicated for LLR than those in other segments. Recent reports from experienced centers document several case series and present technical tips for treating such lesions. The lateral approach using intercostal (transdiaphragmatic) trocars was reported to be useful for lesions in the posterosuperior segments with a semi- to full-decubitus position. The thoracoscopic approach was also reported to be useful for lesions just under the diaphragm dome, but the tumor location and patient selection should be considered carefully because pneumoperitoneum pressure and Pringle’s maneuver cannot be applied. Several case series have described the feasibility of LLR for caudate lobe lesions, with similar operative outcomes to lesions in the posterosuperior segments, but this demands technical expertise. The caudal view of laparoscopy is advantageous for approaching the caudate lobe. We conducted a systematic review to clarify the feasibility of LLR for difficult lesions and discuss its current and future status.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Kenichiro Araki, Norio Kubo, Akira Watanabe & Ken Shirabe

  2. Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan

    Kenichiro Araki, Norio Kubo, Akira Watanabe & Hiroyuki Kuwano

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  1. Kenichiro Araki
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  2. Norio Kubo
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  5. Ken Shirabe
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Correspondence to Ken Shirabe.

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Kenichiro Araki, Norio Kubo, Akira Watanabe, Hiroyuki Kuwano, and Ken Shirabe have no conflicts of interest to declare.

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Araki, K., Kubo, N., Watanabe, A. et al. Systematic review of the feasibility and future of laparoscopic liver resection for difficult lesions. Surg Today 48, 659–666 (2018). https://doi.org/10.1007/s00595-017-1607-6

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