Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 159-161
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.159
Laparoscopic liver resection: Toward a truly minimally invasive approach
Satoshi Ogiso, Etsuro Hatano, Takeo Nomi, Shinji Uemoto
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
Takeo Nomi, Department of Surgery, Nara Medical University, Nara 634-8522, Japan
Author contributions: Ogiso S, Nomi T, Hatano E and Uemoto S designed research; Ogiso S, Nomi T and Hatano E drafted the article; Ogiso S, Nomi T and Hatano E analyzed data; Nomi T, Hatano E and Uemoto S made critical revision; Ogiso S, Nomi T, Hatano E and Uemoto S gave final approval to the article.
Conflict-of-interest: Nothing to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Satoshi Ogiso, MD, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. oggy_so@ybb.ne.jp
Telephone: +81-75-7513242 Fax: +81-75-7514263
Received: December 4, 2014
Peer-review started: December 7, 2014
First decision: December 26, 2014
Revised: January 7, 2015
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: March 16, 2015
Processing time: 105 Days and 19.7 Hours
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.

Keywords: Laparoscopy; Liver resection; Hepatectomy; Minimally-invasive; Parenchyma-sparing; Laparoscopic surgery; Hepatocellular carcinoma; Liver metastasis; Liver lesion; Colorectal carcinoma

Core tip: 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 hepatectomy has been developed for the best remnant liver function as well as sufficient surgical margins and may have positive impacts on morbidity and mortality. Surgeons should overcome the technical difficulty and seek for the possibility of laparoscopic parenchyma-sparing hepatectomy, which will lead laparoscopic hepatectomy toward a truly minimally-invasive and beneficial approach.