الفهرس 
Table of Contents
Laparoscopic Liver Resection (LLR)Only 14 pages are availabe for public view
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Abstract
Laparoscopic liver surgery currently is gaining acceptance in major hepatobiliary pancreatic centers. However, its expansion has been delayed by a number of concerns including the perceived difficulties of maintaining clear margins, the possibility of port-site tumor cell implantation during removal of instruments or tissue, and the risk of hemorrhage. However, reports from a handful of skilled laparoscopic surgeons and the development of specially designed instruments have shown laparoscopic liver surgery to be feasible, safe, and efficient.The role of vascular exclusion including Pringle’s maneuvre seems to be decreasing with improved transection technique. However, it remains a useful technique in reducing bleeding from inflow vessels, especially for surgeons with less experience in liver resection, and recent results show safety of this technique even for prolonged total time of ischemia. Maintenance of low central venous pressure remains an important adjunctive measure to reduce blood loss in liver transection.The experience of the surgeon in practising hepatic surgery, whatever is the method to perform it, is still a factor of primary importance. In spite of that, the advent of new diagnostic instruments, new devices for resection and coagulation, a better knowledge of the liver’s anatomy and pathology, and a closer collaboration with the anaesthetist make the hepatic surgery a kind of surgery more defined and rational. from this point of view, new studies based on the use of different surgical strategies, association of different devices, and employment of different diagnostic and anaesthetic techniques are desirable.Despite improved results of neoadjuvant chemotherapy, resection of hepatic metastases remains possible in only 20–30 % of patients. Radiofrequency ablation is being used increasingly as an alternative to surgical resection of colorectal liver metastases, both in palliative nonresectable cases and in selected technically resectable ones.LLR is a beneficial alternative to OLR in select patients and provides more favorable short-term outcomes such as less overall morbidity, shorter length of hospital stay, less blood loss, lower blood transfusion rate.At the same time, LRR does not compromise oncological outcomes including surgical margin R0, tumor recurrence, disease-free survival, 5-overall survival. Furthermore, LRR even yields a better 3-overall survival. Surgical resection of CLM, where possible remains the most effective treatment to achieve long-term cure; however, optimal patient selection with utility of available imaging techniques and comprehensive multi-disciplinary involvement is paramount to avoiding un-necessary surgical complications and achieving long-term cure Conclusion: Treatment of hepatic metastasis especially in colorectal hepatic lesion could prolong survival in selected cases, all the results of the systemic reviews and meta-analysis suggested an inferior outcome of non resectional treatment compared to hepatic resection. Minimal invasive approach for treatment of CRLM offers more advantages such as early recovery, less pain, better cosmosis, less blood loss, and reduced morbidity and mortality with equal oncological outcome compared to classic open surgery.