Advances in Hepatic Surgery

Abstract

Liver surgery has been evolving over the past years, and complication and mortality rates have gone down markedly. It has become one of the safest surgeries when strict selection criteria are applied. This relies on accurate and reliable preoperative assessment of liver function and the anatomical location of tumor, as well as its relationship to important vascular structures. Precise volumetric measurement of liver segments also allows better prediction of a successful liver resection. Various ways of embolization of the right portal vein can hypertrophy the future liver remnant, increasing the safety profile markedly. At the same time, more and more evidence has shown that laparoscopic surgery can be the standard of care for most liver tumors. This can only be done with the help of advanced technologies, including different energy sources for parenchymal transection and stapling devices for major pedicle and vascular control. On the other hand, liver transplantation is the definitive treatment for liver cirrhosis and its complications. There is evidence that the application of liver transplantation can be extended to some controversial diseases, such as cholangiocarcinoma and colorectal cancers. Liver transplantation using the laparoscopic approach remains experimental and requires further research.