Nösser Maximilian, Feldbrügge Linda, Pratschke Johann
Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
Turk J Surg. 2021 Sep 28;37(3):199-206. doi: 10.47717/turkjsurg.2021.1011. eCollection 2021 Sep.
Minimally invasive liver surgery (MILS) was established as last abdominal surgical specialty through the 1990s. With a shift from mainly benign to malignant indications, MILS was shown to be equal to open liver surgery in terms of oncological outcomes, with benefits in intraoperative blood loss, postoperative pain, postoperative complication rates, hospital length of stay and quality of life. With colorectal liver metastases and hepatocellular carcinoma as the most common indications, most liver resection can be performed minimally invasive nowadays, including patients with liver cirrhosis. Initially perceived limitations of laparoscopic liver surgery were weakened by gaining experience, technical progress and pioneering of new resection approaches. Lately robotic liver surgery was adopted to the field of MILS to further push the limits. To simplify first resections, technical variations of the minimally invasive approach can be utilized, and difficulty scores help to select resections suitable to the level of experience. We hereby give an overview of the establishing of a minimally invasive liver surgery program at our center.
微创肝脏手术（MILS）是在20世纪90年代作为最后一个腹部外科专业建立起来的。随着手术适应症从主要为良性转向恶性，MILS在肿瘤学疗效方面被证明与开放性肝脏手术相当，在术中失血、术后疼痛、术后并发症发生率、住院时间和生活质量方面具有优势。以结直肠癌肝转移和肝细胞癌为最常见适应症，如今大多数肝脏切除术都可以通过微创方式进行，包括肝硬化患者。通过积累经验、技术进步和开拓新的切除方法，腹腔镜肝脏手术最初被认为的局限性得到了缓解。最近，机器人肝脏手术被应用于MILS领域以进一步突破极限。为了简化首次切除术，可以采用微创方法的技术变体，难度评分有助于选择适合经验水平的切除术。在此，我们概述了我们中心微创肝脏手术项目的建立情况。
