Laparoscopic Liver Surgery

摘要: Recent improvements in cross sectional imaging, chemotherapy and advances the techniques of liver resection have resulted rates 5 year survival approaching 60% for patients with colorectal metastasis. Historically was perceived as a formidable operation but now is safe specialist centres should expect low mortality region 1-2%1,2. Consequently, many more are referred its indications continually being revised expanded. At same time there been minimally invasive laparoscopic surgical so much that (LLR) becoming an increasingly popular option amongst enthusiasts. Indeed first described nearly 20 years ago focal nodular hyperplasia3. In recent review by Nguyen colleagues 4,5 over 3,000 resections reported various series meta-analyses 6 7 8. Despite this enthusiasm doubts still remain widespread application because risks complications whether any patient benefit 9-11. The latter very difficult to demonstrate absence well designed randomized controlled trials. Like cholecystectomy came before, it unlikely Randomised trials (RCT) will ever be performed. Perhaps most important RCT done outcome after left lateral versus open resection. Yet enthusiasts advantages obvious they would reluctant offer trial setting. situation different major e.g. right hepatectomy where advantage demonstrate. design few regularly perform large numbers needed high conversion recruiting tumours distributed such away can resected laparoscopically.