Laparoscopic liver resection.

Since the introduction of the laparoscopic cholecystectomy, there has been explosive growth in the field of minimally invasive surgery. Commonly accepted laparoscopic procedures have now come to include bariatric and anti reflux procedures, distal pancreatectomy, splenectomy, hernia repair, and colon resection. The adoption of laparoscopy to the field of liver surgery; however, has been slower to take off. Initial concerns included inadequate exposure and ability to attain hemostasis, fear of gas embolism, and doubts over the oncologic adequacy of the less invasive procedure. The earliest reports of laparoscopic liver surgery were limited to wedge resections for staging or isolated metastases(Lefor, AT & Flowers, JL 1994). Laparoscopic liver resection finally started to gain serious widespread attention after publication of Cherqui’s initial thirty patient experience(Cherqui, D et al 2000). Since that time, the field has seen explosive growth, with over 2,804 cases now described in the world literature(Nguyen, KT et al 2009). Despite its widespread acceptance, laparoscopic liver resection remains a daunting technical challenge suited to a relatively small number of centers that have taken the time and effort to develop concurrent expertise in both open hepatic surgery and laparoscopy. Once these hurdles are overcome; however, laparoscopic liver resection is a safe and highly effective procedure offering numerous patient benefits. In this chapter, we will describe the indications for laparoscopic liver resection, and outline the steps that should be taken by fledgling groups wishing to embark upon creating a laparoscopic liver resection program.