Laparoscopic liver resection: how far can we go?

Abstract

This issue of the Journal of Hepato–Biliary–Pancreatic Surgery focuses on the laparoscopic liver resection and comprises invited reviews and articles. Over the past few years, we have seen a steady rise in publication activity in this subject area (Fig. 1), and it seems appropriate to take stock of where we are in this rapidly emerging field. In 2006, to safely popularize endoscopic liver surgery, the Endoscopic Liver Surgery Study Group was established in Japan. The Second Annual Meeting of Endoscopic Liver Surgery Study Group, which is an ancillary study group of the Japan Society for Endoscopic Surgery, was held in Yokohama in Japan on 1 September 2008 in conjunction with the 21st Annual Meeting of Japan Society for Endoscopic Surgery and the 11th World Congress for Endoscopic Surgery concurrently hosted by President Seigo Kitano of Oita University. As an organizer of the Second Annual Meeting of Endoscopic Liver Surgery Study Group, it is an honor for me to invite reviews and articles from those who were invited speakers for the First International HD Video Symposium at the meeting under the topic ‘‘Current status and future prospects of laparoscopic liver resection.’’ After the first report by Gagner et al. [1], several cases of laparoscopic liver resections were presented at Japanese surgical meetings in 1993–1994 [2–4], and we performed our first laparoscopic liver resection in 1995. Our first patient was an opera singer who underwent laparoscopic colectomy for colon cancer and then developed solitary liver metastasis in the left lateral sector 1 1/2 years later. The patient really wanted to have laparoscopic resection of the liver because she knew laparoscopic surgery would be beneficial for her professional activity due to less damage of the abdominal wall, which is a sort of instrument for an opera singer. Our first laparoscopic liver resection was taped and edited, then submitted to the video Olympics at the 5th World Congress for Endoscopic Surgery in 1996. The video won the gold medal, and that encouraged us to continue this relatively difficult surgery in the early period. Laparoscopic liver resection has been gradually accepted as a choice of treatment for hepatic benign diseases and malignancies in our country. It was not until Kaneko et al. [4] and Azagra et al. [5] reported their series of laparoscopic liver resections, including anatomical resection of the left lateral sector, that many recognized the true feasibility of this procedure. Since Cherqui et al. [6] reported a prospective cohort of 30 patients, several centers have pioneered the field of laparoscopic resection, leading to major hepatectomies, and right lobe living donor hepatectomy [7]. Because the liver is a solid organ, endoscopic liver surgery has unique characteristic viewpoints, and its popularization will take time compared to endoscopic surgery for the gastrointestinal tract, such as the colon and stomach. In addition, an extremely long incision must be made for mobilization and resection because the liver is surrounded by rib bones (Fig. 2). This means that the length of incision required for mobilization and resection can be shortened dramatically if we can conduct mobilization and resection of the liver in the abdominal cavity without slight restriction by rib bones. Therefore, endoscopic surgery is theoretically suited to mobilization and resection of the liver. When we began endoscopic liver surgery in the mid-1990s, it was considered that the level of bleeding occurring in G. Wakabayashi (&) Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan e-mail: gowaka@iwate-med.ac.jp