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Sawa et al. Mini-invasive Surg 2024;8:30 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2024.43

Original Article Open Access

Gradual expansion of the indications for minimally

invasive liver resection to include highly complex
procedures may improve postoperative outcomes

Yui Sawa , Yoshikuni Kawaguchi, Akinori Miyata, Yujiro Nishioka, Akihiko Ichida, Nobuhisa Akamatsu,
Junichi Kaneko, Kiyoshi Hasegawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo,
Tokyo 113-0033, Japan.

Correspondence to: Dr. Kiyoshi Hasegawa, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School
of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: HASEGAWA-2SU@h.u-
tokyo.ac.jp
How to cite this article: Sawa Y, Kawaguchi Y, Miyata A, Nishioka Y, Ichida A, Akamatsu N, Kaneko J, Hasegawa K. Gradual
expansion of the indications for minimally invasive liver resection to include highly complex procedures may improve
postoperative outcomes. Mini-invasive Surg 2024;8:30. https://dx.doi.org/10.20517/2574-1225.2024.43

Received: 12 May 2024 First Decision: 9 Sep 2024 Revised: 25 Oct 2024 Accepted: 4 Nov 2024 Published: 12 Nov 2024

Academic Editors: David A. Geller, Giulio Belli Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
Aim: Liver resection is performed in patients with benign and malignant liver tumors. Advancements in surgical
instruments and improved perioperative management have enabled safe laparoscopic and robotic liver resections.
Herein, we aimed to evaluate the patients who underwent minimally invasive liver resection (MISLR) and compare
their short-term outcomes with those of patients who underwent open liver resection (OLR), according to surgical
complexity.

Methods: Data of patients who underwent liver resection at our institution from January 2011 to August 2023 were
obtained from a prospectively maintained database. We gradually expanded the indications for MISLR from
technically less demanding procedures to intermediate- and high-complexity MISLRs. The procedures were
categorized into three grades (low, intermediate, and high) according to the liver resection complexity
classification.

Results: Of the 1,866 patients who underwent liver resection, 953 were included in the analysis. Of the 953
patients, 781 underwent OLR and 172 underwent MISLR. The operative time and estimated blood loss increased
with the increase in surgical complexity in the MISLR group, which was similar to finding in the OLR group. The
complication rate also increased with the increase in surgical complexity in the OLR group (low complexity vs. high

© The Author(s) 2024. 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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