Laparoscopic liver resection: indications, limitations, and economic aspects
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REVIEW ARTICLE
Laparoscopic liver resection: indications, limitations, and economic aspects Moritz Schmelzle 1 & Felix Krenzien 1 & Wenzel Schöning 1 & Johann Pratschke 1 Received: 16 June 2020 / Accepted: 23 June 2020 # The Author(s) 2020
Abstract Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement. Keywords Laparoscopic liver surgery . Minimally invasive liver surgery . Robotic liver surgery
Introduction Laparoscopic surgery of parenchymatous organs, e.g. liver and pancreas, has been developed relatively late, even though first reports of minimally invasive liver resections were back in the 1990s [1]. The development of laparoscopic liver surgery was accompanied by reservations and questions that have already been cleared or clarified years ago in other areas, such as colorectal surgery. However, as liver surgery differs significantly in many respects, it was not simply a matter of adopting answers from other fields, but of putting the feasibility and usefulness of the laparoscopic technique to the test again. The development has benefited from an early exchange between international pioneers in this field. The organization of consensus and guidelines meetings, e.g., 2008 in
* Moritz Schmelzle [email protected] 1
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Louisville, USA, 2014 in Morioka, Japan, 2018 in Southampton, UK, and later the founding of the International Laparoscopic Liver Society (ILLS), which organized first meetings in Paris in 2017 and Tokyo in 2019, were instrumental in the successful development of safe laparoscopic liver surgery [2–4]. Besides the pioneering spirit of some, its implementation was only made possible by technical innovations and strategic modifications of open surgery. Whi
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