Laparoscopic liver resection

Totally laparoscopic liver resection (TLLR) is still a challenging procedure, although experienced liver surgeons have performed this operation successfully. Between May 1997 and October 2009, 97 patients at Iwate Medical University Hospital underwent TLLR, which included 79 partial resections, 15 left lateral sectionectomies, two S5 subsegmentectomies, and one right hepatectomy. Important considerations in determining indications for TLLR include tumor size, type, and location. Standardization of surgical procedures is also very important for performing surgery safely and efficiently. In a partial liver resection, we prefer to use a pre-coagulation technique using radiofrequency waves to reduce blood loss from the cut surface of the liver parenchyma. The surface of the hepatic parenchyma was transected up to 2 cm without bleeding using ultrasonic coagulating shears. In the left lateral sectionectomy, hepatic parenchyma was thinned on a line left of the falciform ligament by ultrasonic coagulating shears; the portal pedicles and left hepatic vein were divided using an endoscopic linear staplers with a small portion of surrounding liver tissue. This paper reviews the indications and techniques of TLLR for hepatocellular carcinoma.