Wakabayashi Go, Cherqui Daniel, Geller David A, Han Ho-Seong, Kaneko Hironori, Buell Joseph F
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
J Hepatobiliary Pancreat Sci. 2014 Oct;21(10):723-31. doi: 10.1002/jhbp.139. Epub 2014 Aug 5.
Six years have passed since the first International Consensus Conference on Laparoscopic Liver Resection was held. This comparatively new surgical technique has evolved since then and is rapidly being adopted worldwide. We compared the theoretical differences between open and laparoscopic liver resection, using right hepatectomy as an example. We also searched the Cochrane Library using the keyword "laparoscopic liver resection." The papers retrieved through the search were reviewed, categorized, and applied to the clinical questions that will be discussed at the 2nd Consensus Conference. The laparoscopic hepatectomy procedure is more difficult to master than the open hepatectomy procedure because of the movement restrictions imposed upon us when we operate from outside the body cavity. However, good visibility of the operative field around the liver, which is located beneath the costal arch, and the magnifying provide for neat transection of the hepatic parenchyma. Another theoretical advantage is that pneumoperitoneum pressure reduces hemorrhage from the hepatic vein. The literature search turned up 67 papers, 23 of which we excluded, leaving only 44. Two randomized controlled trials (RCTs) are underway, but their results are yet to be published. Most of the studies (n = 15) concerned short-term results, with some addressing long-term results (n = 7), cost (n = 6), energy devices (n = 4), and so on. Laparoscopic hepatectomy is theoretically superior to open hepatectomy in terms of good visibility of the operative field due to the magnifying effect and reduced hemorrhage from the hepatic vein due to pneumoperitoneum pressure. However, there is as yet no evidence from previous studies to back this up in terms of short-term and long-term results. The 2nd International Consensus Conference on Laparoscopic Liver Resection will arrive at a consensus on the basis of the best available evidence, with video presentations focusing on surgical techniques and the publication of guidelines for the standardization of procedures based on the experience of experts.
自首次腹腔镜肝切除术国际共识会议召开以来，已经过去了六年。从那时起，这项相对较新的外科技术不断发展，并在全球范围内迅速得到应用。我们以右肝切除术为例，比较了开放和腹腔镜肝切除术之间的理论差异。我们还使用关键词“腹腔镜肝切除术”检索了Cochrane图书馆。对检索到的论文进行了综述、分类，并应用于即将在第二届共识会议上讨论的临床问题。由于在体腔外操作时受到的动作限制，腹腔镜肝切除术比开放肝切除术更难掌握。然而，位于肋弓下方的肝脏周围手术视野的良好可视性以及放大效果，使得肝实质能够整齐地横断。另一个理论优势是气腹压力可减少肝静脉出血。文献检索共找到67篇论文，其中23篇被排除，仅留下44篇。两项随机对照试验（RCT）正在进行中，但结果尚未发表。大多数研究（n = 15）关注短期结果，一些研究涉及长期结果（n = 7）、成本（n = 6）、能量设备（n = 4）等。由于放大效应，腹腔镜肝切除术在手术视野的良好可视性方面理论上优于开放肝切除术，并且由于气腹压力，肝静脉出血减少。然而，就短期和长期结果而言，以前的研究尚无证据支持这一点。第二届腹腔镜肝切除术国际共识会议将根据现有最佳证据达成共识，视频展示将聚焦于手术技术，并根据专家经验发布手术标准化指南。
