Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, National University of Singapore, Singapore.
State Key Laboratory for Liver Research, Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, China.
Int J Surg. 2020 Oct;82S:169-177. doi: 10.1016/j.ijsu.2020.06.051. Epub 2020 Jul 8.
Laparoscopic liver resection was slow to be adopted in the surgical arena at the beginning as there were major barriers including the fear of gas embolism, risk of excessive blood loss from the inability to control bleeding vessels effectively, suboptimal surgical instruments to perform major liver resection and the concerns about oncological safety of the procedure. However, it has come a long way since the early 1990s when the first successful laparoscopic liver resection was performed, spurring liver surgeons worldwide to start exploring the roles of laparoscopy in major liver resections. Till date, more than 9000 cases have been reported in the literature and the numbers continue to soar as the hepatobiliary surgical communities quickly learn and apply this technique in performing major liver resection. Large bodies of evidence are available in the literature showing that laparoscopic major liver resection can confer improved short-term outcomes in terms of lesser operative morbidities, lesser operative blood loss, lesser post-operative pain and faster recovery with shorter length of hospitalization. On the other hand, there is no compromise in the long-term and oncological outcomes in terms of comparable R resection rate and survival rates of this approach. Many innovations in laparoscopic major hepatectomies for complex operations have also been reported. In this article, we highlight the journey of laparoscopic major hepatectomies, summarize the technical advancement and lessons learnt as well as review the current standards of outcomes for this procedure.
腹腔镜肝切除术在手术领域开始时发展缓慢，因为存在许多主要障碍，包括对气体栓塞的恐惧、由于无法有效控制出血血管而导致大量出血的风险、用于进行大肝切除术的手术器械效果不佳以及对该手术程序的肿瘤学安全性的担忧。然而，自 20 世纪 90 年代初期首次成功进行腹腔镜肝切除术以来，情况已经发生了很大变化，促使全球肝外科医生开始探索腹腔镜在大肝切除术中的作用。迄今为止，文献中已经报道了超过 9000 例病例，并且随着肝胆外科学界迅速学习和应用这项技术进行大肝切除术，病例数量还在不断增加。大量文献证据表明，腹腔镜大肝切除术可以改善短期结果，包括手术并发症更少、手术出血量更少、术后疼痛更少以及恢复更快，住院时间更短。另一方面，在可比的 R 切除率和该方法的生存率方面，该方法的长期和肿瘤学结果并没有受到影响。许多复杂手术的腹腔镜大肝切除术创新也已经被报道。在本文中，我们重点介绍了腹腔镜大肝切除术的发展历程，总结了技术进展和经验教训，并回顾了该手术的当前结果标准。
