Innovative Strategies and Recent Advances in Liver Surgery
1Department of General Surgery & Abdominal Transplantation, Niguarda Hospital, Milan, Italy
2Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
3Department of Surgery, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain
Innovative Strategies and Recent Advances in Liver Surgery
Description
Techniques for hepatic surgery have evolved over the past few decades and have broadened indications for liver resection (LR) for liver disease. New strategies including downsizing chemotherapy, two-stage LR with or without portal vein embolization, and resection combined with ablative methods allow tailoring the treatment to each patient depending on condition of the liver and tumor burden.
In recent years, the new dissector devices have been developed and together with the use of intraoperative ultrasound allow a new approach to the anatomical ultrasound-guided LR even for large tumors located in challenging positions.
The advances in radiology evaluation with high-resolution CT scan or MRI allow new methods for the study of the future liver remnant and play an important role in the planning of the resection strategy reducing the risk of major complications and liver failure, especially in patients who undergo major resection. In addition, development of new technology in local ablative therapies for liver tumors is posing a competition to LR. However, such techniques (i.e., radiofrequency ablation and use of microwaves) also have allowed expansion of indication for LR in patients with multiple tumors.
Minimally invasive approach in this field of surgery is gaining popularity due to the availability of new laparoscopic instruments for liver transection. Laparoscopic LR has evolved significantly over the past decade moving from an experimental procedure to a standard part of the hepatic surgeon's armamentarium. Robotic-assisted technology offers solutions to overcome the limitations of conventional laparoscopic resection. However, its use in LR still remains limited to small reported series, and further evaluation is required to assess the improvement in outcomes after robotic surgery.
The aim of this special issue is to update and promote interchange of the current knowledge and recent progress focusing on innovative strategies and recent advances in liver surgery. Potential topics include, but are not limited to:
- Recent refinements in surgical technique
- Patient's perioperative management
- Advances in radiologic and functional liver evaluation
- Liver resection as a bridge to transplantation
- Two-stage resection
- The role of resection margin
- Laparoscopic and robotic-assisted liver resection
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