Laparoscopic liver resection： Toward a truly minimallyinvasive approach

In the surgical treatment of hepatocellular carcinomaand colorectal liver metastasis, it is important topreserve sufficient liver volume after resection inorder to avoid post-hepatectomy liver sufficiency andto increase the feasibility of repeated hepatectomyin case of intrahepatic recurrence. Parenchymasparingapproach, which minimizes the extent ofresection while obtaining sufficient surgical margins,has been developed in open hepatectomy. Althoughthis approach can possibly have positive impacts onmorbidity and mortality, it is not popular in laparoscopicapproach because parenchyma-sparing resection istechnically demanding especially by laparoscopy due toits intricate curved transection planes. ＂Small incision,big resection＂ is the words to caution laparoscopicsurgeons against an easygoing trend to seek for asuperficial minimal-invasiveness rather than substantialpatient-benefits. Minimal parenchyma excision isoften more important than minimal incision. Recently,several reports have shown that technical evolutionand accumulation of experience allow surgeons toovercome the hurdle in laparoscopic parenchymasparingresection of difficult-to-access liver lesionsin posterosuperior segments, paracaval portion, andcentral liver. Laparoscopic surgeons should now seekfor the possibility of laparoscopic parenchyma-sparinghepatectomy as open approach can, which we believeis beneficial for patients rather than just a small incisionand lead laparoscopic hepatectomy toward a trulyminimally-invasive approach.