Comprehensive application of modern technologies in precise liver resection

摘要

BACKGROUND: Liver  surgery  has  gone  through  the  phases of  wedge  liver  resection,  regular  resection  of  hepatic  lobes, irregular  and  local  resection,  extracorporeal  hepatectomy, hemi-extracorporeal  hepatectomy  and  Da  Vinci  surgical system-assisted  hepatectomy.  Taking  advantage  of  modern technologies,  liver  surgery  is  stepping  into  an  age  of  precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA  SOURCE: PubMed  search  was  carried  out  for  English-language articles relevant to precise liver resection, liver anatomy, hepatic  blood  inflow  blockage,  parenchyma  transection,  and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures,  conduct  risk  assessment,  help  to  identify  the operation  feasibility  and  confirm  the  operation  scheme.  In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver  are  helpful  for  hepatic  blood  inflow  blockage  in precise liver resection. Moreover, the use of exquisite equipment for  liver  parenchyma  transection,  such  as  cavitron  ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood  flow.  Furthermore,  various  down-staging  therapies including transcatheter arterial chemoembolization and radio-frequency  ablation  were  appropriate  for  unresectable  cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible. CONCLUSIONS: Modern  technologies  mentioned  in  this paper are the key tool for achieving precise liver resection and can  effectively  lead  to  maximum  preservation  of  anatomical structural  integrity  and  functions  of  the  remnant  liver.  In addition,  large  randomized  trials  are  needed  to  evaluate  the usefulness of these technologies in patients with hepatocellular carcinoma who have undergone precise liver resection.