Reducing invasiveness in liver surgery-where is the limit?

Abstract

In this article, we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology Surgery. Most prominent advancements in liver surgery in the last two decades are related to refinements in surgical technique (extraglissonean approach) and advancements in surgical technology (laparoscopy and robotics). In this article, authors present both these aspects: Laparoscopic segmentectomy using extraglissonean approach. Furthermore, they describe segmental resections of all 8 segments which is the main novelty that can be observed in the article. By now, extraglissonean approach was thoroughly described mainly in hepatectomies or lateral sectionectomies. Various “hilar gates” are defined which allows safe liver resection by ligating Glissonean pedicles first which is then followed by parenchymal resection. We here focus on past, present and future perspectives of extraglissonean approach and laparoscopic liver resections and comment the value of the presented article.

Keywords: Liver resection; Laparoscopy; Glissonean approach; Segmentectomy

Core Tip: Liver resections are physiologically demanding procedures and there is significant risk of serious intraoperative bleeding as well as postoperative liver failure especially in cases of major hepatectomies. Technical and technological improvements may reduce these risks and extraglissonean laparoscopic approach present most recent improvement in this field. This technique contributes to precision in liver surgery and spares liver parenchyma. However, to employ this technique, a good patient selection and through preoperative planning is required.