Surgical Anatomy and Surgical Landmarks in Laparoscopic Liver Resection
Go Wakabayashi
An operation consists of imaging and manipulation (1).
Imaging
Laparoscopic liver resection has a great merit in imaging because it gives better exposure around the liver located deeply in the rib cage.
Having these thoughts, I realized that laparoscopic liver resection is superior to open liver resection. Laparoscopic procedures give better exposure with magnification and less bleeding under pneumoperitoneal pressure (2).
I wanted to share this idea with liver surgeons among the world and hosted the second international consensus conference on laparoscopic liver resection in October 2014 (3).
The concept of liver surgery changed from open ventral approach to laparoscopic caudal approach.
Manipulation
Pneumo-peritoneal pressure reduces the hepatic vein diameter in soft livers and the parenchymal transection can be performed in a bloodless environment even in exposing the surface of main hepatic veins. However, the essentials in liver resection will never change. The essentials are to expose meticulously anatomical structures hidden inside the liver parenchyma.
The liver is an anatomical organ although most anatomical structures are invisible. Hepatic veins and the Glissonian pedicles are mainly located inside the liver. The Laennec's capsule covers the liver and there are four landmarks and six gates to enter with creating spaces between the Laennec's capsule and the Glissonian pedicles (4).
In this presentation, 3D laparoscopic donor right hepatectomy and 3D laparoscopic central bisectionectomy for HCC located between the anterior section and the medial section with an invasion of the middle hepatic vein will be shown.
You will recognize the importance of surgical anatomy with the landmarks and that the quality improvement of imaging is the key for better laparoscopic liver resection.