Explore the vast range of titles available.

IntroductionMinimally invasive liver resection (MILR) is widely recognized as a safe and beneficial procedure in the treatment of both malignant and benign liver diseases. Hepatolithiasis has traditionally been reported to be endemic only in East Asia, but has seen a worldwide uptrend in recent decades with increasingly frequent and invasive endoscopic instrumentation of the biliary tract for a myriad of conditions. To date, there has been a woeful lack of high-quality evidence comparing the laparoscopic (LLR) and robotic (RLR) approaches to treatment hepatolithiasis.MethodsThis is an international multicenter retrospective analysis of 273 patients who underwent RLR or LRR for hepatolithiasis at 33 centers in 2003–2020. The baseline clinicopathological characteristics and perioperative outcomes of these patients were assessed. To minimize selection bias, 1:1 (48 and 48 cases of RLR and LLR, respectively) and 1:2 (37 and 74 cases of RLR and LLR, respectively) propensity score matching (PSM) was performed.ResultsIn the unmatched cohort, 63 (23.1%) patients underwent RLR, and 210 (76.9%) patients underwent LLR. Patient clinicopathological characteristics were comparable between the groups after PSM. After 1:1 and 1:2 PSM, RLR was associated with less blood loss (p = 0.003 in 1:2 PSM; p = 0.005 in 1:1 PSM), less patients with blood loss greater than 300 ml (p = 0.024 in 1:2 PSM; p = 0.027 in 1:1 PSM), and lower conversion rate to open surgery (p = 0.003 in 1:2 PSM; p < 0.001 in 1:1 PSM). There was no significant difference between RLR and LLR in use of the Pringle maneuver, median Pringle maneuver duration, 30-day readmission rate, postoperative morbidity, major morbidity, reoperation, and mortality.ConclusionBoth RLR and LLR were safe and feasible for hepatolithiasis. RLR was associated with significantly less blood loss and lower open conversion rate.

Background The incidence of hepatocellular carcinoma (HCC) is increasing in the western world over the past decades. As liver resection (LR) represents one of the most efficient treatment options, advantages of anatomic (ALR) versus non‐anatomic liver resection (NALR) show a lack of consistent evidence. Therefore, the aim of this study was to investigate complications and survival rates after both resection types. Methods This is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni‐ and multivariate Cox regression models. Results Two hundred and ninety‐eight patients were included. Median follow‐up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni‐ and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS. Conclusion No significant differences on RFS and OS rates could be observed. Post‐operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post‐operative outcome of these patients. Investigation of Anatomic (ALR) versus non‐anatomic liver resection for hepatocellular carcinoma showed no significant differences on recurrence free survival and overall survival rates. Post‐operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post‐operative outcome of these patients.

Surgical techniques and outcomes of minimally invasive anatomic liver resection (AR) using the extrahepatic Glissonian approach for hepatocellular carcinoma (HCC) are undefined. In 327 HCC cases undergoing 185 open (OAR) and 142 minimally invasive (MIAR; 102 laparoscopic and 40 robotic) ARs, perioperative and long-term outcomes were compared between the approaches, using propensity score matching. After matching (91:91), compared to OAR, MIAR was significantly associated with longer operative time (643 vs. 579 min, p = 0.028); less blood loss (274 vs. 955 g, p < 0.0001); a lower transfusion rate (17.6% vs. 47.3%, p < 0.0001); lower rates of major 90-day morbidity (4.4% vs. 20.9%, p = 0.0008), bile leak or collection (1.1% vs. 11.0%, p = 0.005), and 90-day mortality (0% vs. 4.4%, p = 0.043); and shorter hospital stay (15 vs. 29 days, p < 0.0001). On the other hand, laparoscopic and robotic AR cohorts after matching (31:31) had comparable perioperative outcomes. Overall and recurrence-free survivals after AR for newly developed HCC were comparable between OAR and MIAR, with potentially improved survivals in MIAR. The survivals were comparable between laparoscopic and robotic AR. MIAR was technically standardized using the extrahepatic Glissonian approach. MIAR was safe, feasible, and oncologically acceptable and would be the first choice of AR in selected HCC patients.

Aim Minimally invasive anatomic liver resection (AR) is technically demanding, and the efficacy of robotic surgery in AR remains unestablished. This systematic review aims through a meta‐analysis to compare surgical outcomes between robotic (RAR) and conventional laparoscopic (LAR) AR. Methods A systematic literature search of relevant studies published between 2001 and 2024 in PubMed/MEDLINE, Embase and Cochrane Library was carried out, and 15 studies were selected. Meta‐analysis was performed to compare perioperative outcomes between RAR and LAR. Results A total of 4171 patients comprising 2042 RAR and 2129 LAR patients who underwent major hepatectomy or liver parenchyma‐sparing AR (PSAR) were included. All included studies were retrospective comparative studies, including eight using propensity score‐matched analysis. Meta‐analysis demonstrated that as primary outcomes, the 30‐day and 90‐day mortalities and postoperative overall morbidity were comparable between RAR and LAR, while RAR had significantly less morbidity≥Clavien‐Dindo grade II and a lower rate of open conversion. As secondary outcomes, compared to LAR, RAR showed significantly less blood loss and shorter postoperative hospital stay, while RAR had a higher rate of postoperative 30‐day readmission. Operative time, blood transfusion, Pringle maneuver, R0 resection, and reoperation were comparable. Subgroup meta‐analyses showed a lower rate of blood transfusion in robotic PSAR and a lower rate of open conversion in RAR in the right cranial regions. Conclusion This large‐scale meta‐analysis of minimally invasive AR suggests that RAR can confer comparable or partly better perioperative outcomes as compared to LAR, indicating potential advantages of the robotic approach to AR. Minimally invasive anatomic liver resection (AR) including major hepatectomy and liver parenchyma‐sparing AR is technically complex and demanding. This systematic review with meta‐analysis including 15 studies comparing 2042 robotic AR and 2129 laparoscopic AR patients demonstrated largely comparable perioperative outcomes and partly better outcomes including significantly less major postoperative morbidity, a lower rate of open conversion, less blood loss, and shorter postoperative hospital stay in robotic AR. These results suggest potential perioperative advantages conferred by robotic surgery over laparoscopic surgery for this type of complex liver resection.

Introduction Cirrhotic patients with primary liver cancer may undergo curative-intent resection when selected appropriately. Patients with T1 tumors and low-MELD are generally referred for resection. We aim to evaluate whether minimally invasive hepatectomy (MIH) is associated with improved outcomes versus open hepatectomy (OH). Methods NSQIP hepatectomy database 2014–2021 was used to select patients with T1 Hepatocellular Carcinoma (HCC) or Intra-hepatic Cholangiocarcionoma (IHCC) and low-MELD cirrhosis (MELD ≤ 10) who underwent partial hepatectomy. Propensity score matching was applied between OH and MIH patients, and 30-day postoperative outcomes were compared. Multivariable regression was used to identify predictors of post-hepatectomy liver failure (PHLF) in the selected population. Results There were 922 patients: 494 (53.6%) OH, 372 (40.3%) MIH, and 56 (6.1%) began MIH converted to OH (analyzed with the OH cohort). We matched 354 pairs of patients with an adequate balance between the groups. MIH was associated with lower rates of bile leak (HR 0.37 [0.19–0.72)], PHLF (HR 0.36 [0.15–0.86]), collections requiring drainage (HR 0.30 [0.15–0.63]), postoperative transfusion (HR 0.36 [0.21–0.61]), major (HR 0.45 [0.27–0.77]), and overall morbidity (HR 0.44 [0.31–0.63]), and a two-day shorter median hospitalization (3 vs. 5 days; HR 0.61 [0.45–0.82]). No difference was noted in operative time, wound, respiratory, and septic complications, or mortality. Regression analysis identified ascites, prior portal vein embolization (PVE), additional hepatectomies, Pringle’s maneuver, and OH (vs. MIH) as independent predictors of PHLF. Conclusion MIH for early-stage HCC/IHCC in low-MELD cirrhotic patients was associated with improved postoperative outcomes over OH. These findings suggest that MIH should be considered an acceptable approach in this population of patients.

This review traces the author's personal journey over three decades in the evolution of liver resection techniques, culminating in the proposal of the Bona Fide Intersegmental Plane Hepatectomy Along Glissonean Branches (BIPHG). Beginning with pioneering experiences in laparoscopic and robotic liver surgeries, the author highlights key anatomical insights—particularly Laennec's capsule and intersegmental planes—that have advanced surgical precision. Transitioning from laparoscopy‐assisted to pure laparoscopic donor hepatectomy illustrated the importance of safety, visualization, and anatomy‐guided dissection. Inspired by innovations in intraoperative imaging and microanatomy, the author introduces BIPHG—an innovative tension‐based technique utilizing indocyanine green (ICG) fluorescence to define natural intersegmental boundaries along Glissonean branches. This method emphasizes real‐time visualization, enabling accurate, minimally invasive, and function‐preserving liver resections. The review underscores the significance of standardizing definitions and assessment tools, such as the difficulty score, to facilitate broader adoption. Looking forward, ongoing technological and anatomical advances are expected to further refine these approaches, positioning BIPHG as a promising, safe, and precise strategy in minimally invasive liver surgery. This personal narrative aims to contribute to the continued evolution of anatomy‐based, minimally invasive hepatic resection techniques. This review proposes Bona Fide Intersegmental Plane Hepatectomy along the Glissonean Branches (BIPHG), a minimally invasive, anatomy‐based liver transection technique using Glissonean control and ICG fluorescence to identify the true intersegmental plane. Controlled tension—especially in robotic surgery—enables precise, efficient, and parenchyma‐sparing anatomical liver resection, supporting safe and reproducible minimally invasive practice.

Laparoscopic liver resection (LLR) is widely accepted; however, no prospective study has identified risk factors for conversion to open surgery. This multicenter prospective study aimed to identify risk factors for conversion to hand-assisted laparoscopic surgery or open liver resection and evaluate the impact of conversion on perioperative outcomes in LLR. From June 2020 to May 2024, patients scheduled for wedge resection or left lateral segmentectomy for solitary liver tumor < 5 cm were enrolled across seven institutions. A laparoscopic approach was employed for all patients. The primary endpoint was the identification of risk factors for conversion. As secondary endpoints, we compared perioperative outcomes between LLR and conversion. Among 199 patients, 172 (86.4%) completed LLR, while 27 (13.6%) required conversion. Multivariate analysis identified third or subsequent liver resection ( P  < 0.001) and male sex ( P  = 0.029) as significant risk factors for conversion. Conversion was significantly associated with longer operative time ( P  = 0.001), greater blood loss ( P  < 0.001), decreased implementation of the Pringle maneuver ( P  = 0.013), and prolonged hospital stay ( P  = 0.001). These findings highlight that conversion negatively impacts short-term outcomes. Awareness of these risk factors may support better surgical planning and risk stratification for patients undergoing LLR.

Background The outcomes of minimally invasive liver surgery for posterosuperior segments (PS) are still debated. Since the results of ongoing trials focusing on the results of laparoscopic liver resection (LLR) and robotic liver resection (RLR) in this setting are still awaited, the best evidence currently comes from retrospective propensity-score matched (PSM) studies. The aim of this meta-analysis was to assess the outcomes of RLR for difficult located lesions and to provide evidence for its use in clinical practice. Methods A systematic review with meta-analysis was conducted to evaluate the safety and efficacy of LLR and RLR for PS segments. The Medline, Embase and Web of Science Library electronic databases were searched to identify available research published up to June 2024. Results Five studies with a total of 2907 patients (RLR: n  = 1084; LLR: n  = 1823) were included in the meta-analysis. The RLR group had less estimated blood loss (EBL) (MD: − 88.3, 95% CI − 144.2–− 32.3; p  = 0.012), fewer blood transfusions (OR 0.70, 95% CI 0.39–0.80, p  = 0.033), and a shorter operative time (MD − 27.3, 95% CI − 49.4–− 5.1; p  = 0.027). No differences in postoperative morbidity, mortality and R1 resection rates were observed. Conclusion RLR for lesions in the PS segments are safe and effective, and may have superior surgical outcomes than LLR.

ObjectiveHow different surgical procedures, including the robotic-assisted liver resection (RLR) and laparoscopic liver resection (LLR), can affect the prognosis of patients with liver malignancies is unclear. Thus, in this study, we compared the effects of RLR and LLR on the surgical and oncological outcomes in patients with liver malignancies through propensity score-matched cohort studies.MethodsThe PubMed, Embase, and Cochrane databases were searched using Medical Subject Headings terms and keywords from inception until May 31, 2023. The quality of the included studies was assessed using the Newcastle–Ottawa quality assessment scale. The mean difference with 95% confidence interval (95% CI) was used for analysis of continuous variables; the risk ratio with 95% CI was used for dichotomous variables; and the hazard ratio with 95% CI was used for survival-related variables. Meta-analysis was performed using a random-effects model.ResultsFive high-quality cohort studies with 986 patients were included (370 and 616 cases for RLR and LLR, respectively). In terms of surgical outcomes, there were no significant differences in the operation time, conversion rate to open surgery, overall complication rate, major complication rate, and length of hospital stay between the RLR and LLR groups. In terms of oncological outcomes, there were no significant differences in the 5-year overall survival and disease-free survival between the two groups.ConclusionSurgical and oncological outcomes are comparable between RLR and LLR on patients with liver malignancies. Therefore, the benefits of applying RLR in patients with liver malignancies need to be further explored.

Recurrence of liver cancers after liver resection (LR), such as recurrences of hepatocellular carcinoma and colorectal liver metastases, is often treated with repeat LR (RLR) as the only curative treatment. However, RLR is associated with an increased risk of complications. The indications for the currently emerging laparoscopic LR and its advantages and disadvantages for repeat treatment are still under discussion. Our multi-institutional propensity-score matched analyses of laparoscopic vs. open RLRs for hepatocellular carcinoma showed the feasibility of laparoscopic RLR with comparable short- and long-term outcomes. Small blood loss and low morbidity was observed in selected patients treated using laparoscopic RLR in which total adhesiolysis can be dodged, with speculations that laparoscopic minor repeated LR can minimize functional deterioration of the liver. However, there are several disadvantages, such as easily occurring disorientation and difficulty in repeated wide-range dissection of Glissonian pedicles. Recently emerging small anatomical resection, indocyanine green fluorescence-guided surgery, and robot-assisted surgery are promising tools for the further development of laparoscopic RLR. This review discusses how laparoscopic RLR, as a powerful unique local therapy causing less damage to the residual liver and surrounding structures, could contribute to the outcomes of repeated treatments for cancers and its future perspectives.