| セッション情報 | 招待講演(消化器外科学会)Laparoscopic liver surgery and future directions |
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| タイトル | 招待講演4：Laparoscopic liver surgery and future directions |
| 演者 | K.-H. Kim（Asan Medical Center, University of Ulsan College of Medicine） |
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| 抄録 | Laparoscopic surgery for liver resection is increasingly common, but it is not yet widely accepted and remains controversial among liver surgeons. The indications for laparoscopic liver resection are still limited, primarily due to the difficulty involved in mobilizing the liver and ensuring adequate resection margins, the risk of injury to major branches of the hepatic vein during dissection of the hepatic parenchyma, a difficult learning curve, the risks of tumor seeding and wound metastases, and potential differences in long-term outcome are major concerns in laparoscopic surgery. Anatomical liver resection involves the complete removal of a liver segment or sub-segment that receives blood through the segmental or sub-segmental portal vein, respectively. Theoretically, performing anatomical liver resection along the major vessels exposed to eradicate the small pedicles is the best way to prevent intrahepatic metastasis occurring via vascular invasion and post-operative complications such as bile leakage and bleeding. This anatomical liver resection is applying to laparoscopic liver resection more and more. Recently, laparoscopic major liver resections including complicated liver resection such as central hepatectomy, VIII segmentectomy are performed at specialized centers by hepatobiliary surgeons skilled in minimally invasive techniques. To improve the technique of LLR, more flexible instrument and better vision of a camera, just similar to robotic surgical system, seem to be necessary. Surgeons who want to do LLR well should try to know the liver anatomy accurately and do anatomical resection so as to upgrade the quality of LLR to the same level of open liver resection. |
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