Liver Resection: Right Lobectomy

Abstract

Safe liver surgery has been performed for the past three decades. Before the 1980s, the mortality rate associated with liver resections was above 20%, mostly related to massive hemorrhage. Improved anesthesia and postoperative care, in addition to a better understanding of the liver’s anatomy, reduced mortality rates to less than 5% in specialized centers. Laparoscopic liver surgery started in the mid-1990s [1]. The recent advances in laparoscopic devices and the development of liver parenchymal transection equipment led to an increased performance of laparoscopic liver resections in recent years. Although laparoscopy has been shown to be a safe and feasible approach [2–9], major hepatectomies are being performed in few centers [1]. In expert hands, oncologic and clinical outcomes have proven to be equivalent to those of the open technique [10–13], with the benefits of minimally invasive surgery (early recovery, shorter hospitalization, and better cosmetic outcomes) [14]. Limitations of laparoscopic surgery such as the restricted movement of the instruments and two-dimensional view, the complexity of these procedures, and the potential risk of major bleeding during the parenchymal transection are some of the obstacles preventing a wider application of laparoscopy in liver resections [1].