Minimally invasive anatomic liver resection: results of a survey of world experts
Mamoru Morimoto 1 , Kazuteru Monden 2 , Taiga Wakabayashi 3 , Naoto Gotohda 4 , Yuta Abe 3 , Goro Honda 5 , Mohammed Abu Hilal 6 , Takeshi Aoki 7 , Horacio J Asbun 8 , Giammauro Berardi 9 , Albert C Y Chan 10 , Rawisak Chanwat 11 , Kuo-Hsin Chen 12 , Yajin Chen 13 , Daniel Cherqui 14 , Tan To Cheung 15 , Ruben Ciria 16 , David Fuks 17 , David A Geller 18 , Ho-Seong Han 19 , Kiyoshi Hasegawa 20 , Etsuro Hatano 21 , Osamu Itano 22 , Yukio Iwashita 23 , Hironori Kaneko 24 , Yutaro Kato 25 , Ji Hoon Kim 26 , Rong Liu 27 , Santiago López-Ben 28 , Fernando Rotellar 29 , Yoshihiro Sakamoto 30 , Atsushi Sugioka 25 , Tomoharu Yoshizumi 31 , Keiichi Akahoshi 32 , Felipe Alconchel 33 , Shunichi Ariizumi 5 , Andrea Benedetti Cacciaguerra 34 , Manuel Durán 35 , Alain García Vázquez 36 , Nicolas Golse 37 , Yoshihiro Miyasaka 38 , Yasuhisa Mori 39 , Satoshi Ogiso 40 , Chikara Shirata 20 , Federico Tomassini 41 , Takeshi Urade 42 , Hitoe Nishino 43 , Filipe Kunzler 44 , Shingo Kozono 43 , Hiroaki Osakabe 43 , Chie Takishita 43 , Daisuke Ban 45 , Taizo Hibi 46 , Norihiro Kokudo 47 , Masayuki Ohtsuka 48 , Yuichi Nagakawa 43 , Takao Ohtsuka 49 , Minoru Tanabe 32 , Masafumi Nakamura 39 , Masakazu Yamamoto 5 , Akihiko Tsuchida 43 , Go Wakabayashi 50
Background: Although the number of minimally invasive liver resection (MILR) has been steadily increasing in many institutions, minimally invasive anatomic liver resection (MIALR) remains a complicated procedure that has not been standardized. We present the results of a survey among expert liver surgeons as a benchmark for standardizing MIALR.
Method: We administered this survey to 34 expert liver surgeons who routinely perform MIALR. The survey contained questions on personal experience with liver resection, inflow/outflow control methods, and identification techniques of intersegmental/sectional planes (IPs).
Results: All 34 participants completed the survey; 24 experts (70%) had more than 11 years of experience with MILR, and over 80% of experts had performed over 100 open resections and MILRs each. Regarding the methods used for laparoscopic or robotic anatomic resection, the Glissonean approach (GA) was a more frequent procedure than the hilar approach (HA).
Although hepatic veins were considered essential landmarks, the exposure methods varied. The top three techniques that the experts recommended for identifying IPs were creating a demarcation line, indocyanine green (ICG) negative staining method, and intraoperative ultrasound.
Conclusion: MIALR remains a challenging procedure; however, a certain degree of consensus exists among expert liver surgeons.