Mamoru Morimoto1, Kazuteru Monden2, Taiga Wakabayashi3, Naoto Gotohda4, Yuta Abe3, Goro Honda5, Mohammed Abu Hilal6, Takeshi Aoki7, Horacio J Asbun8, Giammauro Berardi9, Albert C Y Chan10, Rawisak Chanwat11, Kuo-Hsin Chen12, Yajin Chen13, Daniel Cherqui14, Tan To Cheung15, Ruben Ciria16, David Fuks17, David A Geller18, Ho-Seong Han19, Kiyoshi Hasegawa20, Etsuro Hatano21, Osamu Itano22, Yukio Iwashita23, Hironori Kaneko24, Yutaro Kato25, Ji Hoon Kim26, Rong Liu27, Santiago López-Ben28, Fernando Rotellar29, Yoshihiro Sakamoto30, Atsushi Sugioka25, Tomoharu Yoshizumi31, Keiichi Akahoshi32, Felipe Alconchel33, Shunichi Ariizumi5, Andrea Benedetti Cacciaguerra6, Manuel Durán16, Alain García Vázquez34, Nicolas Golse35, Yoshihiro Miyasaka36, Yasuhisa Mori37, Satoshi Ogiso21, Chikara Shirata20, Federico Tomassini38, Takeshi Urade39, Hitoe Nishino40,41, Filipe Kunzler8, Shingo Kozono40, Hiroaki Osakabe40, Chie Takishita40, Daisuke Ban42, Taizo Hibi43, Norihiro Kokudo44, Masayuki Ohtsuka41, Yuichi Nagakawa40, Takao Ohtsuka45, Minoru Tanabe32, Masafumi Nakamura37, Masakazu Yamamoto5, Akihiko Tsuchida40, Go Wakabayashi46. 1. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 2. Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan. 3. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 4. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan. 5. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 6. Department of Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. 7. Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan. 8. Hepato-Biliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA. 9. Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy. 10. Division of Liver Transplantation, Hepatobiliary & Pancreatic Surgery, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China. 11. Hepato-Pancreato-Biliary Surgery Unit, Department of Surgery, National Cancer Institute, Bangkok, Thailand. 12. Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan. 13. Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. 14. Hepatobiliary Center, Paul Brousse Hospital, Paris, France. 15. Department of Surgery, The University of Hong Kong, Hong Kong, China. 16. Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, IMIBIC, Cordoba, Spain. 17. Department of Digestive and Oncologic Surgery, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. 18. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 19. Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. 20. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 21. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 22. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan. 23. Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan. 24. Division of General and Gastroenterological Surgery, Department of Surgery, Faculty of Medicine, Toho University, Tokyo, Japan. 25. Department of Surgery, Fujita Health University, Aichi, Japan. 26. Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Gyeonggi-do, Korea. 27. Faculty of Hepato-pancreato-biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Chinese PLA General Hospital, Beijing, China. 28. General Surgery Department, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain. 29. HPB and Liver Transplant Unit, Clínica Universidad de Navarra, Pamplona, Spain. 30. Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan. 31. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 32. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 33. Department of Surgery and Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Virgen de la Arrixaca), Murcia, Spain. 34. Institute of Image-Guided Surgery of Strasbourg, Strasbourg, France. 35. Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France. 36. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan. 37. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 38. General and Emergency Surgery Unit, GB Grassi Hospital, Rome, Italy. 39. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 40. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 41. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 42. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan. 43. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. 44. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan. 45. First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan. 46. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan.
Abstract
BACKGROUND: Although the number of minimally invasive liver resections (MILRs) has been steadily increasing in many institutions, minimally invasive anatomic liver resection (MIALR) remains a complicated procedure that has not been standardized. We present the results of a survey among expert liver surgeons as a benchmark for standardizing MIALR. METHOD: We administered this survey to 34 expert liver surgeons who routinely perform MIALR. The survey contained questions on personal experience with liver resection, inflow/outflow control methods, and identification techniques of intersegmental/sectional planes (IPs). RESULTS: All 34 participants completed the survey; 24 experts (70%) had more than 11 years of experience with MILR, and over 80% of experts had performed over 100 open resections and MILRs each. Regarding the methods used for laparoscopic or robotic anatomic resection, the Glissonean approach (GA) was a more frequent procedure than the hilar approach (HA). Although hepatic veins were considered essential landmarks, the exposure methods varied. The top three techniques that the experts recommended for identifying IPs were creating a demarcation line, indocyanine green negative staining method, and intraoperative ultrasound. CONCLUSION: Minimally invasive anatomic liver resection remains a challenging procedure; however, a certain degree of consensus exists among expert liver surgeons.
BACKGROUND: Although the number of minimally invasive liver resections (MILRs) has been steadily increasing in many institutions, minimally invasive anatomic liver resection (MIALR) remains a complicated procedure that has not been standardized. We present the results of a survey among expert liver surgeons as a benchmark for standardizing MIALR. METHOD: We administered this survey to 34 expert liver surgeons who routinely perform MIALR. The survey contained questions on personal experience with liver resection, inflow/outflow control methods, and identification techniques of intersegmental/sectional planes (IPs). RESULTS: All 34 participants completed the survey; 24 experts (70%) had more than 11 years of experience with MILR, and over 80% of experts had performed over 100 open resections and MILRs each. Regarding the methods used for laparoscopic or robotic anatomic resection, the Glissonean approach (GA) was a more frequent procedure than the hilar approach (HA). Although hepatic veins were considered essential landmarks, the exposure methods varied. The top three techniques that the experts recommended for identifying IPs were creating a demarcation line, indocyanine green negative staining method, and intraoperative ultrasound. CONCLUSION: Minimally invasive anatomic liver resection remains a challenging procedure; however, a certain degree of consensus exists among expert liver surgeons.