Department of Surgery, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, USA.
Semin Liver Dis. 2013 Aug;33(3):226-35. doi: 10.1055/s-0033-1351780. Epub 2013 Aug 13.
Laparoscopic liver surgery has evolved over the last two decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver resection (LLR). In this review, the authors highlight the modern indications, benefits, safety, and feasibility of laparoscopic liver resections. Moreover, they analyze various studies comparing laparoscopic major hepatectomies to open surgery. Morbidity and mortality rates are at an all-time low in this era of laparoscopic liver surgery. The role of laparoscopy for oncologic resections is compared with open liver resections. Attention is given to oncologic margins and survival rates. In addition, the authors examine the safety and efficacy of LLR for nontraditional laparoscopic segments and tumors abutting major hepatic vasculature. Various resection techniques are reviewed including the use of the hanging-maneuver and modern stapling devices. Finally, they examine several novel techniques for laparoscopic liver resections including the hybrid technique, as is used in laparoscopic living donor hepatectomies, the use of hand-assistance to avoid conversion to open surgery, and the use of the robotic platform to aid in complex biliary or vascular reconstructions. Current barriers to laparoscopic liver surgery will continue to fall over the next decade.
腹腔镜肝手术在过去的二十年中不断发展。手术技术、手术技术和术后护理的进步，有助于克服腹腔镜肝切除术 (LLR) 的障碍。在这篇综述中，作者强调了腹腔镜肝切除术的现代适应证、益处、安全性和可行性。此外，他们分析了各种比较腹腔镜大肝切除术与开腹手术的研究。在腹腔镜肝手术的这个时代，发病率和死亡率处于历史最低水平。腹腔镜用于肿瘤切除术的作用与开腹肝切除术进行了比较。重点关注了肿瘤学边缘和生存率。此外，作者还研究了腹腔镜非传统肝段和靠近主要肝血管的肿瘤切除术的安全性和有效性。包括使用悬垂手法和现代吻合器在内的各种切除技术进行了回顾。最后，他们研究了腹腔镜肝切除术的几种新方法，包括用于腹腔镜活体供肝切除术的杂交技术、使用手辅助以避免转为开腹手术，以及使用机器人平台辅助复杂的胆道或血管重建。未来十年，腹腔镜肝手术的障碍将继续减少。
