The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.

Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka

Objective:To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses.Summary Background Data:There are no updated pooled data since 2009 about the current status and short-term out

Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing.

Objective:The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.Background:The exponential growth of laparoscopic liver surgery in recent

/pdf/the-southampton-consensus-guidelines-for-laparoscopic-liver-2bpp7uh1oi.pdf

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation.

Objective: To review the literature on current management of hepatocellular carcinoma (HCC). Background: Hepatocellular carcinoma represents one of the most common malignancies worldwide with a rising incidence in western countries. There have been substantial advances in the surgical and medical treatment of HCC within the past 2 decades. Methods: A literature review was performed in the MEDLINE database to identify studies on the management of HCC. On the basis of the available evidence recommendations for practice were graded using the Oxford Centre for Evidence-based Medicine classification. Results: Advances in surgical technique and perioperative care have established surgical resection and orthotopic liver transplantation (OLT) as primary curative therapy for HCC in noncirrhotic and cirrhotic patients, respectively. Primary resection and salvage OLT may be indicated in cirrhotics with preserved liver function. Selection criteria for OLT remain debated, as slight expansion of the Milan criteria may not worsen prognosis but is limited by organ shortage and prolonged waiting time with less favorable outcome on intention-to-treat analyses. Strategies of neoadjuvant treatment before OLT require evaluation within prospective trials. Transarterial chemoembolization is the primary therapy in patients with inoperable HCC and compensated liver function. Although systemic chemotherapy is not effective in patients with advanced HCC, there is recent evidence that these patients benefit from new molecular targeted therapies. If these agents are also effective in the neoadjuvant and adjuvant setting is currently being investigated. Furthermore, selective intra-arterial radiation therapy represents a promising new approach for treatment of unresectable HCC. Conclusions: Recent developments in the surgical and medical therapy have significantly improved outcome of patients with operable and advanced HCC. A multidisciplinary approach seems essential to further improve patients' prognosis.

Hepatocellular carcinoma: current management and perspectives for the future.

Early on, laparoscopic liver resection (LLR) was limited to partial resection, but major LLR is no longer rare. A difficulty scoring system is required to guide sur- geons in advancing from simple to highly technical laparo- scopic resections. Subjects were 90 patients who had undergone pure LLR at three medical institutions (30 patients/institution) from January 2011 to April 2014. Sur- gical difficulty was assessed by the operator using an index of 1-10 with the following divisions: 1-3 low difficulty, 4-6 intermediate difficulty, and 7-10 high difficulty. Weighted kappa statistic was used to calculate the concordance between the operators' and reviewers' (expert surgeon) dif- ficulty index. Inter-rater agreement (weighted kappa statis- tic) between the operators' and reviewers' assessments was 0.89 with the three-level difficulty index and 0.80 with the 10-level difficulty index. A 10-level difficulty index by linear modeling based on clinical information revealed a weighted kappa statistic of 0.72 and that scored by the extent of liver resection, tumor location, tumor size, liver function, and tumor proximity to major vessels revealed a weighted kappa statistic of 0.68.We proposed a new scoring system to predict difficulty of various LLRs preoperatively. The calculated score well reflected difficulty.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jhbp.166

A novel difficulty scoring system for laparoscopic liver resection.

Objective:To summarize the current world position on laparoscopic liver surgery.Summary Background Data:Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver re

The international position on laparoscopic liver surgery: The Louisville Statement, 2008.

Summary Background Data: Multiple series have reported on the safety andefﬁcacy of laparoscopic liver surgery. Small and medium sized procedures havebecome commonplace in many centers, while major laparoscopic liver resec-tions have been performed with efﬁcacy and safety equaling open surgery inhighly specialized centers. Although the ﬁeld has begun to expand rapidly, noconsensus meeting has been convened to discuss the evolving ﬁeld of laparo-scopic liver surgery. Methods: On November 7 to 8, 2008, 45 experts in hepatobiliary surgery wereinvitedtoparticipateinaconsensusconferenceconvenedinLouisville,KY,US.In addition, over 300 attendees were present from 5 continents. The conferencewas divided into sessions, with 2 moderators assigned to each, so as to stimulatediscussion and highlight controversies. The format of the meeting varied fromformal presentation of experiential data to expert opinion debates. Written andvideo records of the presentations were produced. Speciﬁc areas of discussionincluded indications for surgery, patient selection, surgical techniques, compli-cations, patient safety, and surgeon training.

Clark Gamblin

Papers

The international position on laparoscopic liver surgery: The Louisville Statement, 2008.

The International Position on Laparoscopic Liver Surgery