ASO Author Reflections: Laparoscopic Anatomical Resections: Where We Are and Where Should We Go

Excerpt

In the last decades, the minimally invasive surgical approach to liver malignancies has been established as safe in experienced hands. At the same time, anatomical liver resections (ARs) result in improved oncological outcomes in the surgical treatment of hepatocellular carcinoma.1 Despite this, ARs are challenging operations to perform using a pure laparoscopic technique, especially when lesions are located in the posterosuperior segments. Furthermore, different opinions still exist worldwide on what should be considered anatomical. Indeed, most surgeons believe that the resection of one segment relying on the anatomical borders of major veins and identifying the feeding pedicle during parenchymal transection could be safely defined as anatomical. On the other hand, identifying the pedicle as the first step through the Glissonian approach from the liver hilum, and relying on the ischemia obtained by clamping, is necessary for other surgeons, especially in the East. However, this approach is certainly more difficult from a laparoscopic point of view and no reliable data currently exist.2,3 …