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Lo et al. Mini-invasive Surg 2022;6:36 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.52

Editorial Open Access

Minimally invasive liver surgery - rise of a new era

Winifred Lo, David A. Geller

Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
Correspondence to: Dr. David A. Geller, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of
Pittsburgh Medical Center, MUH 7S, 3459 Fifth Ave Pittsburgh, Pittsburgh, PA 15213, USA. E-mail: gellerda@upmc.edu

How to cite this article: Lo W, Geller DA. Minimally invasive liver surgery - rise of a new era. Mini-invasive Surg 2022;6:36.
https://dx.doi.org/10.20517/2574-1225.2022.52
Received: 24 May 2022 Accepted: 7 Jun 2022 Published: 28 Jun 2022

Academic Editor: Giulio Belli Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Minimally invasive surgery (MIS) has improved the perioperative risk, hospital stay, and patient satisfaction
with operations for lung cancer, colon cancer, and prostate cancer. Hepatobiliary surgery has been more
cautious in integrating minimally invasive approaches due to concerns for the quality of oncologic resection
and safety. Over the last 20 years, considerable advances have been made demonstrating comparable safety
and oncologic efficacy in minimally invasive liver surgery. This special edition of MIS seeks to describe the
recent advances to improve safety and efficacy in minimally invasive approaches, as well as novel strategies
to consider for future procedures.

Prior clinical studies have demonstrated that laparoscopic liver surgery can provide safe and equitable
[1]
results when compared with open liver resections . In a meta-analysis reviewing over 9000 MIS liver
surgery cases, laparoscopic surgery was associated with fewer complications, less blood loss, fewer
transfusions, and shorter hospital stay . This was achieved without significantly increasing the length of
[2]
operative time, either for minor or major resections. However, laparoscopic liver surgery should not be
utilized by low-volume or inexperienced providers. Review of our institution’s experience with laparoscopic
liver resection from 2001 to 2017 suggests a significant improvement in operative time, blood transfusions,
use of pure laparoscopic approach, and post-operative complications over a 15-year period of
[3]
implementation and optimization . Further, surgeons should be familiar with practice guidelines for
improving operative safety, including anatomic landmarks, strategic approaches for dissection (i.e.,
Glissonian approach, hepatic vein guided approach), and trouble-shooting when encountering issues with
[4]
dissection and bleeding .

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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