• hepatectomy
• hepatobiliary surgery
• laparoscopic liver resection
• open liver resection
• post-operative complications

• outcomes research
• colorectal cancer

• Male
• Humans
• Female
• Aged
• Rectum/surgery
• Laparoscopy/methods
• Rectal Neoplasms/surgery
• Rectal Neoplasms/complications
• Proctectomy/methods
• Administration, Rectal
• Treatment Outcome
• Postoperative Complications/etiology

• CRLM
• HCC
• colorectal cancer liver metastasis
• hepatocellular carcinoma
• laparoscopic hepatectomy
• laparoscopic liver resection
• open liver resection

• hepatectomy
• hepatocellular carcinoma
• quality of life
• sarcopenia

• Outcomes
• laparoscopic
• survival

• “benign liver tumours”
• “hepatobiliary surgery”
• “hepatocellular carcinoma”
• “intra-operative bleeding”
• “laparoscopic hepatectomy”
• “minimally invasive”
• “open liver resection”
• “post-hepatectomy bleeding”
• “post-operative complications”
• “segmentectomy”. the term and “versus” was used to identify studies which compared the outcomes of both techniques

• Blood Loss, Surgical/statistics & numerical data
• Blood Transfusion/statistics & numerical data
• Conversion to Open Surgery/statistics & numerical data
• Hepatectomy/adverse effects
• Hepatectomy/economics
• Hepatectomy/methods
• Hepatectomy/statistics & numerical data
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/economics
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Length of Stay/statistics & numerical data
• Liver Neoplasms/economics
• Liver Neoplasms/surgery
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/economics
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/statistics & numerical data
• Treatment Outcome

• cirrhosis
• hepatectomy
• hepatocellular carcinoma
• laparoscopy
• liver surgery
• portal hypertension
• robotic

The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC.

Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic.

Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P <  0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P <  0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups.

Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

• Hepatocellular carcinoma
• Laparoscopic surgery
• Major liver resection
• Meta-analysis

• Lotus energy device
• laparoscopy
• liver cancer
• major hepatectomy
• propensity score matching analysis

• Carcinoma
• Hepatectomy
• Hepatocellular
• Laparoscopy
• Liver neoplasms

The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma.

We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines.

From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46).

The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.

The online version of this article (10.1007/s00464-018-6431-6) contains supplementary material, which is available to authorized users.

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Meta-analysis
• Systematic review

• hepatocellular carcinoma
• laparoscopic
• open liver resection

In addition to general advantages of laparoscopic over open surgery, such as better cosmesis and faster recovery, laparoscopic liver surgery offers specific advantages. Improved liver function and potentially earlier postoperative oncologic treatment are suggested by the literature as benefits of laparoscopic over open liver surgery. The purpose of this analysis was to analyze the outcomes of laparoscopic liver surgery in our department.

All laparoscopic liver resections (LLRs) performed from January 2011 through July 2016 were identified from the institutional database and matched 1:2 to open liver resections (OLRs). Data were analyzed regarding perioperative outcome, and significance was set at P < .05.

Of 1525 liver resections, 120 patients were included in this analysis. Forty resections were performed laparoscopically. Patients in the LLR group more often had benign tumors. No patient died after LLR, but 2 required conversion to open surgery (5%) because of bleeding. Blood loss (200 vs 500 mL, P < .001) was less and hospital stay (6 vs. 7 days, P = .001) shorter after LLR. Iwate score, operating time, and the size of the resection margins did not differ between the groups. Iwate score correlated with operative time (P = .027).

Laparoscopic liver surgery was safe, and several advantages over open surgery were confirmed in our series.

• Iwate score
• Laparoscopic liver surgery
• Match-pair analysis

• Laparoscopic hepatectomy
• Liver neoplasms
• Meta-analysis
• Robotic-assisted hepatectomy

• hepatectomy
• meta-analysis
• surgery

• Hepatocellular carcinoma
• Laparoscopy
• Minimally invasive liver resection
• Open
• Resection

The aim of this study is to compare the safety and efficacy of conventional laparotomy with those of robotic and laparoscopic approaches to hepatectomy.

Independent reviewers conducted a systematic review of publications in PubMed and Embase, with searches limited to comparative articles of laparoscopic hepatectomy with either conventional or robotic liver approaches. Outcomes included total operative time, estimated blood loss, length of hospitalization, resection margins, postoperative complications, perioperative mortality rates, and cost measures. Outcome comparisons were calculated using random-effects models to pool estimates of mean net differences or of the relative risk between group outcomes. Forty-nine articles, representing 3702 patients, comprise this analysis: 1901 (51.35%) underwent a laparoscopic approach, 1741 (47.03%) underwent an open approach, and 60 (1.62%) underwent a robotic approach. There was no difference in total operative times, surgical margins, or perioperative mortality rates among groups. Across all outcome measures, laparoscopic and robotic approaches showed no difference. As compared with the minimally invasive groups, patients undergoing laparotomy had a greater estimated blood loss (pooled mean net change, 152.0 mL; 95% confidence interval, 103.3–200.8 mL), a longer length of hospital stay (pooled mean difference, 2.22 days; 95% confidence interval, 1.78–2.66 days), and a higher total complication rate (odds ratio, 0.5; 95% confidence interval, 0.42–0.57).

Minimally invasive approaches to liver resection are as safe as conventional laparotomy, affording less estimated blood loss, shorter lengths of hospitalization, lower perioperative complication rates, and equitable oncologic integrity and postoperative mortality rates. There was no proven advantage of robotic approaches compared with laparoscopic approaches.

• Hepatectomy
• Laparoscopy
• Meta-analysis
• Minimally invasive surgery
• Robotics

Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

• Minimally invasive surgery
• Laparoscopic surgery
• Hand-assisted laparoscopy
• Liver neoplasm
• Liver cirrhosis
• Living donor
• Liver
• Hepatectomy
• Liver transplantation

• Laparoscopic
• cirrhosis
• hepatocellular carcinoma (HCC)
• liver resection (LR)
• portal hypertension (PHT)

AIM: To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).

METHODS: A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as “laparoscopy”, “hepatectomy”, and “hepatocellular carcinoma”. A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.

RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.

CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.

• Hepatocellular carcinoma
• Laparoscopy
• Open liver resection
• Hepatectomy
• Surgery

• Hepatocellular carcinoma
• laparoscopic
• meta-analysis
• open hepatectomy
• surgery

• Hepatectomy/standards
• Humans
• Liver Diseases/surgery
• Outcome Assessment, Health Care/methods
• Quality Assurance, Health Care/methods
• Time Factors

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Open liver resection

Liver resection (LR) for hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD) is associated with high risks of developing significant postoperative complications and multicentric metachronous lesions, which can result in the need for repeated treatments. Studies comparing laparoscopic procedures to open LR consistently report reduced blood loss and transfusions requirements, lower postoperative morbidity, and shorter hospital stays, with no differences in oncologic outcomes. In addition, laparoscopic LR is associated with reduced postoperative ascites and a lower incidence of liver failure for HCC patients with CLD, due to the reduced surgery-induced parenchymal injury to the residual liver and limited destruction of the collateral blood/lymphatic flow around the liver. Finally, this procedure facilitates subsequent repeat LR due to minimal adhesion formation and improved vision/manipulation between adhesions. These characteristics of laparoscopic LR may lead to an expansion of the indications for LR. This editorial is based on the review and meta-analysis presented at the 2^nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan, in October 2014 (Chairperson of the congress is Professor Go Wakabayashi from the Department of Surgery, Iwate Medical University School of Medicine), which is published in the Journal of Hepato-Biliary-Pancreatic Sciences.

• Laparoscopic
• Liver resection
• Hepatocellular carcinoma
• Chronic liver disease
• Liver failure
• Ascites
• Indication
• Repeat hepatectomy

AIM: To perform a systematic review and meta-analysis on robotic-assisted vs laparoscopic liver resections.

METHODS: A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria: (1) studies comparing robotic and laparoscopic liver resection; (2) studies reporting at least one perioperative outcome; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.

RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time (MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.

CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.

• Laparoscopic liver resections
• Robotic liver resections
• Outcome
• Systematic review
• Meta-analysis

• Adult
• Aged
• Aged, 80 and over
• Blood Loss, Surgical
• Chi-Square Distribution
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Hepatectomy/mortality
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Length of Stay
• Male
• Middle Aged
• Odds Ratio
• Operative Time
• Postoperative Complications/mortality
• Risk Factors
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/mortality
• Time Factors
• Treatment Outcome

Accumulation of experiences and technological advances after the first report of laparoscopic liver resection (LLR) are now revealing the characteristics and specific advantages of this approach, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases (CLD). In laparoscopic approach, there are minimum needs for: (1) laparotomy and dissection of the attachments and adhesion which may cause destructions in the collateral blood and lymphatic flows; and (2) compression of the liver which may cause parenchymal damage for the liver resection (LR). These are especially beneficial for the patients with CLD. LLR results in minimal postoperative ascites and the other complications, which could potentially lead to lowering the risk of fatal liver failure. These characteristics of LLR facilitate surgical treatment application to the patients of HCC with background CLD. Laparoscopic approach also results in improved vision and manipulation in a small operative field under several conditions, including the cases where it is necessary to perform repeat LR between adhesions. These characteristics make LLR safer and more accessible to the repeat treatment, such as multicentric and metachronous lesions in the cirrhotic liver. These advantages of LLR indicate it is a superior method than open LR under certain conditions in patients of HCC with background CLD.

• Laparoscopic hepatectomy
• Hepatocellular carcinoma
• Liver cirrhosis
• Chronic liver disease
• Liver tumor
• Liver resection
• Repeat hepatectomy
• Bridging therapy to transplantation
• Ascites
• Postoperative liver failure

• Chronic liver disease
• Hepatocellular carcinoma
• Laparoscopic liver resection
• Repeat hepatectomy

AIM: To review the published literature about laparoscopic liver resection for malignancy.

METHODS: A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed.

RESULTS: All forms of hepatic resections have been described ranging from simple wedge resections to extended right or left hepatectomies. The usual approach is pure laparoscopic, but hand-assisted, as well as robotic approaches have been described. Most studies showed comparable results to open resection in terms of operative blood loss, postoperative morbidity and mortality. Many of them showed decreased postoperative pain, shorter hospital stays, and even lower costs. Oncological results including resection margin status and long-term survival were not inferior to open resection.

CONCLUSION: In the hands of experienced surgeons, laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts.

• Laparoscopic liver resection
• Laparoscopy
• Laparoscopic liver surgery
• Hepatectomy
• Liver malignancy

• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Postoperative Complications/etiology
• Risk Factors
• Treatment Outcome

• colorectal liver metastasis
• colorectalis májáttét
• hepatocellular carcinoma
• hepatocellularis carcinoma
• laparoscopic liver surgery
• laparoscopos májresectio

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The association of HCC with chronic liver disease (CLD) is well known and making treatment complex and challenging. The treatment of HCC must take into consideration, the severity of CLD, the stage of HCC, and the clinical condition of the patient. Liver resection (LR) is one of the most efficient treatments for patients with HCC. Better liver function assessment, increased understanding of segmental liver anatomy using more accurate imaging studies, and surgical technical progress are the important factors that have led to reduced mortality, with an expected 5 year survival of 38–61% depending on the stage of the disease. However, the procedure is applicable to <30% of all HCC patients, and 80% of the patients after LR recurred within 5 years. There are recent advances and prospects in LR for HCC in several aspects. Three-dimensional computed tomography imaging assisted preoperative surgical planning facilitates unconventional types of LR. Emerging evidences of laparoscopic hepatectomy and prospects for the use of newly developing chemotherapies as a combined therapy may lead to expanding indication of LR. LR and liver transplantation could be associated rather than considered separately with the current concepts of “bridging LR” and “salvage transplantation.”

• 3-dimensional computed tomography
• chemotherapy
• hepatocellular carcinoma
• laparoscopic hepatectomy
• liver resection

• Laparoscopic liver resection (LLR)
• hepatocellular carcinoma (HCC)
• morbidity
• outcome
• review
• survival

Liver resection for hepatocellular carcinoma (HCC) is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis. The aim of this review is to assess current indications, advantages and limits of laparoscopic surgery for HCC resections. We also discussed the possible evolution of this surgical approach in parallel with new technologies.

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Hepatectomy
• Minimally invasive
• Review
• Laparoscopic resection of gastrointestinal

• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Diffusion of Innovation
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Postoperative Complications/etiology
• Risk Factors
• Treatment Outcome

• Critical Pathways
• Diet Therapy/nursing
• Early Ambulation/nursing
• Hepatectomy/nursing
• Hepatectomy/rehabilitation
• Humans
• Length of Stay
• Liver Neoplasms/nursing
• Liver Neoplasms/surgery
• Pancreatectomy/nursing
• Pancreatectomy/rehabilitation
• Postoperative Care/nursing
• Randomized Controlled Trials as Topic
• Recovery of Function
• Treatment Outcome