Principles of Laparoscopic Liver Resections

• The laparoscopic liver resection procedure has evolved over the last two decades from a novel segmental operation to an established procedure with proven efficacy and safety in skilled hands.

• Adoption of laparoscopic liver resection has been variable among centers from 5-70% of resections. Throughout its evolution, numerous techniques and devices have been introduced into the field since the original description of pure laparoscopic approach. These innovations include stapler hepatectomy, hand-assist devices, single port access, and robotics.

• Laparoscopic liver resection was initially applied to the management of peripheral benign tumors and subsequently adapted for the routine management of malignant tumors. Multiple studies have subsequently confirmed the oncological non-inferiority of laparoscopic liver resection.

• Laparoscopic liver resection has been accepted as the standard of care for left lateral sectionectomy while major hepatectomy continues to evolve as a standard of care. Laparoscopic live donor hepatectomy and major robotic resections continue to be areas of investigation that have been recommended to proceed in the setting of a prospective study.