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BACKGROUND This study aims to compare the short- and long-term outcomes of patients undergoing minimally invasive liver resection (MILR) versus open liver resection (OLR) for nonrecurrent hepatocellular carcinoma (HCC). METHODS Review of 204 MILR and 755 OLR without previous LR performed between 2005 and 2018. 1:1 coarsened exact matching (CEM) and 1:1 propensity-score matching (PSM) were performed. RESULTS Overall, 190 MILR were well-matched with 190 OLR by PSM and 86 MILR with 86 OLR by CEM according to patient baseline characteristics. After PSM and CEM, MILR was associated with a significantly longer operation time [230 min (interquartile range [IQR], 145-330) vs. 160 min (IQR, 125-210), p

BACKGROUND Controversy exists regarding the safety and feasibility of minimally invasive resection for lesions in segments 7 or 8. We compare outcomes of minimally invasive surgery (MIS) and Open parenchymal sparing liver resections at two high-volume centers. METHODS From 2003 to 2016 we identified patients who underwent MIS or Open resections for lesions in segments 7 or 8 at two institutions (MSKCC and SGH). Outcomes were compared using univariate and multivariate analyses. RESULTS Two-hundred and forty-five patients underwent resection of lesions in segments 7 or 8 (MIS 30% and Open 70%). Compared to the Open group, the MIS group had longer operative time (223 ± 88 vs 188 ± 72 minutes, P = .003), lower blood loss (297 ± 287 vs 448 ± 670 mL, P = .03), and shorter mean length of stay (5.2 ± 7.4 vs 8.3 ± 11.7 days, P

Colorectal liver metastases (CLM) are not always resectable at the time of diagnosis. An insufficient future liver remnant is a factor excluding patients from curative intent resection. To deal with this issue, two-stage hepatectomy was introduced approximately 20 years ago. It is a sequential treatment strategy for bilateral CLM, which consists of preoperative chemotherapy, portal vein embolization, and planned first and second liver resections. This study reviews current evidence supporting use of two-stage hepatectomy.

Purpose The surgical navigation system that provides guidance throughout the surgery can facilitate safer and more radical liver resections, but such a system should also be able to handle organ motion. This work investigates the accuracy of intraoperative surgical guidance during open liver resection, with a semi-rigid organ approximation and electromagnetic tracking of the target area. Methods The suggested navigation technique incorporates a preoperative 3D liver model based on diagnostic 4D MRI scan, intraoperative contrast-enhanced CBCT imaging and electromagnetic (EM) tracking of the liver surface, as well as surgical instruments, by means of six degrees-of-freedom micro-EM sensors. Results The system was evaluated during surgeries with 35 patients and resulted in an accurate and intuitive real-time visualization of liver anatomy and tumor's location, confirmed by intraoperative checks on visible anatomical landmarks. Based on accuracy measurements verified by intraoperative CBCT, the system's average accuracy was 4.0 ± 3.0 mm, while the total surgical delay due to navigation stayed below 20 min. Conclusions The electromagnetic navigation system for open liver surgery developed in this work allows for accurate localization of liver lesions and critical anatomical structures surrounding the resection area, even when the liver was manipulated. However, further clinically integrating the method requires shortening the guidance-related surgical delay, which can be achieved by shifting to faster intraoperative imaging like ultrasound. Our approach is adaptable to navigation on other mobile and deformable organs, and therefore may benefit various clinical applications.

The robotic system has emerged as a new minimally invasive technology with promising results. We sought to systematically review the available literature on the safety and the oncologic outcomes of robotic liver surgery. A systematic review was conducted using Medline (PubMed), Embase and Cochrane library through November 12th, 2017. A robotic approach may be a safe and feasible surgical option for minor and major liver resections.

In this video we describe our method for performing a robotic abdominoperineal resection, posterior vaginectomy and distal sacrectomy. We present the case of a 75y female with a recurrence of her rectal cancer on a background of extensive abdominal operations. She was initially diagnosed in 2014 at which time she underwent chemoradiotherapy. This was followed by two liver resections and a Hartmann's procedure. She received radiotherapy in 2018 for a metastatic right upper lobe lung lesion. She has also had a hysterectomy and cholecystectomy and has hypothyroidism and hypertension.

Aim Robotic surgery is thought to have a role in widening the application of minimally invasive liver surgery. Nonetheless, data concerning surgical results for liver malignancies are presently still lacking. We aimed to evaluate the surgical and oncological outcomes of ultrasound guided robotic liver resections for hepatic malignancies. Methods All consecutive patients who received robotic resection of primary and secondary liver malignancies from September 2008 to January 2017 were analyzed. The same surgical team performed all procedures following the principle of parenchymal-sparing surgery. Results From a total of 51 patients, 13 patients (25%) underwent major and 38 (75%) minor hepatectomy. No mortality occurred. Two procedures were converted to open surgery. Five patients experienced major complications, with a reintervention rate of 6%. Median hospital stay was 5 days. Conclusions Robotic surgery is a safe and feasible procedure for liver resection even when dealing with malignancies. Our data show that robotic surgery can be considered a valid option to treat patients with liver malignancies in a minimally invasive manner, without compromise the oncological results.

BACKGROUND Hepatic resectional surgery remains a highly specialized area of general surgery usually reserved for completion at tertiary metropolitan referral centres. Port Macquarie, on the Mid North Coast of New South Wales, is the only regionally based hospital offering surgery of this nature in mainland Australia. The purpose of this study is to review the data for patients undergoing hepatic resectional surgery in this non-metropolitan centre in order to illustrate that these operations can be carried out safely in a regional setting with comparable results to tertiary-level centres. METHODS A retrospective review of consecutive patients undergoing elective hepatic resections at Port Macquarie from February 2008 to 31 October 2015 was completed. Pre-morbid patient clinical and demographic factors, histopathological details, post-operative complications, survival and mortality data were all noted. RESULTS A total of 66 consecutive elective liver resections were performed during the study period. Metastatic colorectal cancer was the most commonly observed pathology (n = 33, 50.0%). The 90-day mortality was 4.5% (n = 3) whilst 17 patients (n = 17, 25.8%) experienced major complications (Clavien-Dindo grade 3 or 4). The median overall survival following hepatectomy for colorectal metastases was 48 months (95% confidence interval 37-59 months). CONCLUSION Our study shows excellent morbidity, mortality and survival for hepatic resectional surgery performed in a regional centre and is comparable data to major metropolitan centres. Our study confirms that major hepatic resectional surgery in this setting is safe and effective.

Background There has been a recent interest in the use of Indocyanine green (ICG) imaging. The aim of this study is to review our initial experience in liver surgery. Methods ICG fluorescent imaging was used in 15 patients undergoing surgical treatment of their liver tumors between 2015 and 2016. ICG imaging was initially performed, followed by intraoperative ultrasound (IOUS). Findings on fluorescence were compared with preoperative cross-sectional imaging and IOUS. Result Sixty-two lesions were identified, with 34 located superficially and 28 deeply in the liver. While 13 patients underwent surgery for malignant liver metastases, two patients had operations for benign liver diseases. Seven patients underwent open or robotic liver resections, five laparoscopic microwave liver ablation, and three diagnostic laparoscopy. ICG identified all of the superficial lesions. IOUS identified 98% of all lesions. The most benefit of ICG was in showing the margins of the superficial lesions in real-time and guiding surgical treatment, which was limited by IOUS. Conclusion This is the first North American study to evaluate the potential utility of ICG during liver surgery. Its major benefit seems to be in providing real-time feedback to the surgeon about the margins of superficial tumors for resection or ablation. J. Surg. Oncol. 2016;114:625–629. © 2016 Wiley Periodicals, Inc.

Objective The aim of this study was to validate clinical risk scores in patients underwent laparoscopic resection of colorectal liver metastases (CLM) with 5 years follow-up or more, and assess 5- and 10-year actual survival in this group. Methods A total of 516 laparoscopic liver resections were performed in 406 patients with CLM between February 1998 and September 2015. A follow-up of 5 and 10 years could be assessed in 144 and 29 patients, respectively. The Fong score, pre- and postoperative Basingstoke Predictive Index (BPI), Nordlinger score, and Iwatsuki score were validated. Results Five- and ten-year cancer-related actual survival was 54% and 32%, respectively. The Fong score, pre- and postoperative BPI and the Nordlinger score divided patients into risk groups with significant difference in survival between the groups. However, predicted 5-year survival rates were lower than the actual 5-year survival (mean difference in 17%,13%, 20%, and 30%, respectively). Conclusion The Fong score, pre- and postoperative BPI and the Nordlinger score systems can be used to predict survival for laparoscopically operated patients in the era of multimodal-treatment after adjusting of survival rates. The actual five- and 10-year survival after laparoscopic resection of CLM is similar to results previously published for open liver resection. J. Surg. Oncol. 2016;114:757-763. © 2016 Wiley Periodicals, Inc.

Background Repeat liver resection is effective for recurrent hepatocellular carcinoma (rHCC). This study aimed to determine the outcomes of laparoscopic repeat liver resection (LRLR) for rHCC. Methods Eight consecutive patients who underwent LRLR for rHCC were retrospectively reviewed. Results Six patients had previous open and two had laparoscopic liver resection (LLR). There was one (12.5%) open conversion for bleeding and one (12.5%) post-operative morbidity. The median tumour size was 24 mm (range: 8–50 mm). LRLR was performed for rHCC in the ipsilateral lobe as compared to the index surgery in 4/8 (50%) patients. Five of eight (62.5%) patients had rHCC in the difficult posterosuperior segments. Six patients had previous open LR, and two had previous LLR. One patient (patient 4) had two prior open LR for rHCC, and LRLR was performed for the second recurrence. The median duration from the first surgery to LRLR was 29 months (range: 6–109 months). The median post-operative stay was 3.5 days. All eight patients had R0 resections, and at a median follow-up of 7.5 months, all patients were disease-free. Conclusion LRLR for rHCC is feasible and safe. This can be performed even for patients with previous open liver resections, cirrhosis, lesions in the posterosuperior segments and prior LR of the ipsilateral lobe. LRLR for rHCC is feasible and safe in highly selected patients.

Key Clinical Message A 30‐year‐old lady treated with capecitabine for primary colon adenocarcinoma developed liver lesions suspicious for metastasis. Liver biopsies showed sinusoidal dilatation thought to be secondary to capecitabine. This case highlights the importance of differentiating between benign and malignant liver lesions during cancer surveillance preventing unnecessary liver resections for benign disease.

Growing data suggest that minimally invasive approaches in hepatic surgery may improve postoperative outcomes without differences in terms of oncological results compared to open resections. These facts have contributed to the growing adoption of this technique for selected patients.However, expertise in both hepatic and advanced laparoscopic surgery is required in order to safely perform laparoscopic liver resections. We present a video depicting technical details for a totally laparoscopic left hepatectomy for hepatocellular carcinoma with left portal vein thrombosis in a cirrhotic patient.

Aim Besides the residual liver volume, damage of the microcirculation secondary to increased portal blood flow is a main determinant of postoperative liver failure (PLF). Endothelin-1 (ET-1), produced by sinusoidal endothelial cells, plays a key role in the regulation of hepatic microcirculation. The aim of this study was to determine whether ET-1 levels has any prognostic utility in predicting PLF. Methods Patients undergoing liver resection for primary or secondary liver tumors at San Raffaele Hospital, Milan, were prospectively enrolled in the study. Serial postoperative serum ET-1 levels in patients undergoing liver resections were correlated with indices of inflammatory response, liver failure and death. Results A total of 144 patients were included. ET-1 levels in patients who underwent major or extended liver resection were significantly higher than in patients who had a minor resection on postoperative day (POD) 1 (P = 0.003), POD 2 (P = 0.0001) and POD 5 (P = 0.0001). Eight patients developed PLF and ET-1 was significantly higher compared with patients without PLF on POD 2 (P = 0.002) and POD5 (P = 0.006). Serum ET-1 concentration on POD 2 was an independent predictor of PLF in multivariate analysis. Conclusion ET-1 is as an early index of PLF and provides a rationale for therapeutic manipulation, with many potential clinical implications to prevent PLF onset and reduce its severity.

Background and Objectives Extent of liver resections are restricted by the volume of the future liver remnant. Different strategies have been developed to increase the frequency of curative resections. Selective internal radiation therapy (SIRT) has emerged as an effective therapy for patients with primary non-resectable malignancies of the liver. Here, we report the first clinical series of patients with curative liver resection following SIRT. Methods Starting 2010, patients with marginally resectable liver metastases treated by SIRT followed by liver resection were identified and prospectively documented in a database for subsequent retrospective analysis. Results Thirteen patients (five female, eight male; age 70 years [32–77 years]) with marginally resectable liver metastases were selected for liver resection after SIRT. After performing SIRT, 12 patients had potentially curative hepatic resection. In two patients, liver resection after SIRT could not be performed due to the appearance of new extrahepatic metastases. Analyzing the effect of SIRT, we observed a decrease in tumor size with central scaring. None of the patients developed liver necrosis after SIRT. Liver resection was performed safely in all patients. Conclusions The combination of SIRT with state-of-the-art liver surgery opens up new therapeutic options in patients with liver metastases. J. Surg. Oncol. 2015; 112:436–442. © 2015 Wiley Periodicals, Inc.

Laparoscopic liver resection has been adopted slowly due to concerns for bleeding and oncologic outcomes. Currently, over 9,500 laparoscopic liver resections have been performed and reported worldwide. Numerous studies have shown the safety and oncologic equivalence of laparoscopic liver resection when compared to open resection. Pure laparoscopic and hand-assisted laparoscopic liver resection are the two most commonly used techniques for minimally invasive liver resection surgery. Advantages of the hand-port include tactile feedback, facilitation of liver mobilization, and ease of ability to control bleeding. We present a case report with video of a hand-assisted laparoscopic left liver resection for a hepatocellular carcinoma in a non-cirrhotic patient.

Background Conversion to open during minimally invasive liver resection has a high rate. To identify the reasons to convert could help in defining a strategy to decrease the event "conversion." Methods A systematic review has been performed. Our large series of robotic hepatic resections were analyzed and included in the review. Results Fifty papers were selected and carefully evaluated in full text. Twenty-nine were ultimately used for analysis, including all published robotic liver resections. Our series included 11 conversions out of 139 patients (7.9%). Adhesions were not a declared reason to convert. The robotic approach still had a high percentage of open conversions because of difficulties in assessing the tumor margin. Conclusions Causes for conversion were carefully analyzed and compared with what previously described for the pure laparoscopic approach. This could be crucial in defining how to improve the performance and minimize the conversion rate.

Laparoendoscopic single-site surgery (LESS) aims to reduce incision-related complications by using a single surgical access through which multiple instruments are inserted simultaneously. First descriptions of LESS procedures date back to the early 90 s, but the approach initially failed to gain popularity because of technical challenges that markedly impair the principles of laparoscopic ergonomics. In recent years LESS has been increasingly applied to hepatobiliary procedures including cholecystectomies and liver resections. However, the uptake of LESS in hepatobiliary is limited. The surgical robotic platform might play a fundamental role in facilitating the uptake of LESS by the surgical community since robotic science made it possible to develop adequate technology to deal with some of the LESS issues such as restoring surgical triangulation. In this paper the current state-of-the-art for robotic LESS applied to the hepatobiliary system and emerging technologies enabling safer LESS procedures have been reviewed and future perspectives commented on the light of our experience.

Background The aim of this study was to compare the risk scores of Fong et al., Nordlinger et al., and the TNM classification of colorectal liver metastases proposed by the UICC. Methods Data from 282 consecutive patients undergoing 303 liver resections for metastatic colorectal cancer between 1995 and 2006 at the Department of Surgery, University of Erlangen were analyzed. The median follow-up time was 34 months. A curative (R0) resection was performed in 92% of the patients. Results Applying the clinical risk score of Fong with preoperative data identified three risk groups. The survival rates between “low risk” (n = 22) and “intermediate risk” (n = 222) diverged (P = 0.073). The survival rates between “intermediate risk” and “high risk” (n = 59) differed significantly (P = 0.030). Using the risk scoring system of Nordlinger, patients were divided into two risk groups (i.e., “low risk” (n = 218) and “intermediate risk” (n = 68)). Significant differences in survival between the groups were noted (P = 0.012). Applying the clinical TNM classification of colorectal liver metastases revealed no significant differences in survival between the risk groups. Conclusions Our study found the clinical risk score developed by Fong et al. to be a reliable preoperative prognostic tool for selecting patients for surgical resection of colorectal liver metastases. J. Surg. Oncol. 2009;100:349–357. © 2009 Wiley-Liss, Inc.

Aim: Although most partial liver resections are performed for malignant lesions, an increasing contingent of benign lesions is also considered for surgery. The aim was to assess post-operative morbidity and mortality after liver resection for benign hepatobiliary lesions in comparison with outcome after resection of malignant lesions. Methods: A total of 286 liver resections were undertaken between January 1992 and December 2004. After exclusion of resection for bile duct tumours or hepatocellular carcinoma, 205 partial liver resections were retrospectively analysed. Results: Patients with benign lesions comprised 34% of the group (n=70). Benign lesions mainly consisted of focal nodular hyperplasia (n=12; 17%) and liver haemangiomas (11; 15.7%). The malignant lesions consisted of colorectal tumour metastases (n=121; 89%). Patients with benign lesions predominantly underwent minor liver resections (66 vs. 47%; P=0.013). The overall post-operative morbidity occurred in 31% (64/205). Major morbidity occurred in 16% (22/135) in the malignant group compared with 9% (6/70) in the benign group (P=0.099). No differences were seen in major post-operative morbidity in the earlier period compared with the later period (14 vs. 14.3%, P=0.950). In multivariate analysis, only presence of comorbidity (P=0.017), prolonged surgical procedure (P=0.021) and surgical irradicality (P=0.039) maintained significance as independent risk factors for major morbidity. Conclusion: Limited liver resections for the treatment of a wide range of benign hepatobiliary lesions are associated with low morbidity and no mortality. However, the indications must be assessed with care. The presence of comorbidity, prolonged surgical time and incomplete resections were associated with major morbidity.

Background Surgical treatment of hilar cholangiocarcinoma (Klatskin tumours) is difficult because of its central location in the liver hilum. Recent developments in surgical techniques have improved the outcome after resection. Aim To describe the surgical approaches currently applied in our centre and the impact of these strategies on outcome and criteria for resection. Methods From 1988 to 2003, 99 consecutive patients underwent resection for hilar cholangiocarcinoma. Patients were analysed for rate of RO resections in relation with Bismuth classification. Morbidity, mortality and survival were assessed. Results The rate of hilar resections in combination with (extended) liver resections for type III and IV tumours increased from 24% to 95% in the last 5 years of the study period. Eight patients (8%) had Bismuth type IV tumours. Four of these patients underwent palliative local excisions of the hepatic duct confluence whereas the other four patients underwent hilar resection in combination with partial liver resection, resulting in microscopically radical resections. There was no mortality in this group. Overall postoperative morbidity and mortality were 68% and 10%, respectively. Conclusions An aggressive surgical approach consisting of hilar resections combined with partial liver resections including segments 1 and 4, resulted in a higher rate of RO resections. Even Bismuth type IV tumours may be resectable depending on the biliary anatomy of the hepatic duct confluence.

Small rodents are the most used experimental models in liver surgical research. Hepatic resections in rodents are commonly performed to study liver regeneration, acute liver failure, hepatic metastasis, hepatic function, 'small-for-size' transplantation and metabolic response to injury. Most resections require only basic skills, are fast, reliable and highly reproducible. The partial hepatectomy technique in rodents can be improved by microsurgical techniques, which permit individualized dissection and ligature of the vascular and biliary branches with minimal operative morbidity and mortality. This is particularly relevant for murine models of liver resection. However, it requires advanced microsurgical skills. Here, we review the models, surgical techniques, results and limitations of partial liver resections in rodent models. We also reported for the first time segmentectomies of the median lobe in rodent models.

Background The intraoperative blood loss and the biliary leak constitute the major causes of postoperative morbidity following liver resection. We describe a new technique for liver parenchyma transection using the Atlas modification of the ligasure vessel sealing system. The gradual closure of the instrument may cause crushing of the hepatic tissue and heat sealing of the vessels and bile ducts at the same time. Materials and Methods Ten cirrhotic patients (group A) underwent minor liver resections due to hepatocellular carcinoma (HCC). In four of these patients a bisegmentectomy was carried out, whereas in the remaining six the resection involved one segment. In addition, twelve patients with localized metastatic liver disease (group B) underwent tissue preserving hepatectomy also. Six of these patients underwent a bisegmentectomy and six had a local resection involving one segment. Results The blood loss in the first group varied from 120 to 350 ml, whereas in the second group varied from 80 to 280 ml. No postoperative biliary leakage was mentioned. Conclusion This alternative technique of dividing the hepatic parenchyma seems to be simple and efficacious in preventing significant blood loss and bile leak in minor liver resections. J. Surg. Oncol. 2008;97:165–168. © 2007 Wiley-Liss, Inc.

Dramatic improvements in morbidity and mortality rates following liver resections have been reported in the past decade. Consequently, the indications for hepatectomy are becoming more liberal. Many techniques of liver resection with or without vascular clamping have been reported with excellent clinical results. Total vascular exclusion (TVE) of the liver during parenchymal transection has been advocated susceptible to increase the resectability of tumors that might not be safely approached by other techniques. Cirrhotic livers are probably more vulnerable to ischemic injury related to TVE than normal livers. The indications and technical and metabolic aspects of the technique are reviewed.

The knowledge of segmental liver anatomy has provided the fundamental basis for segmental liver resections. Formerly described by Couinaud [1] as right paramedian sectorectomy, right anterior liver resection or bi-segmentectomy V-VIII is defined as the removal of segments V and VIII of the liver. Among several types of liver resection, bi-segmentectomy V-VIII is one of the most difficult to perform. Makuuchi et al. [2] were the first authors to present detailed operative technique and clinical data regarding this procedure. The main drawback of this technique is a complex hilar plate dissection including individual identification of arterial, portal, and bile duct branches of right anterior liver segments (V and VIII). We have recently described a modification of the intrahepatic posterior technique with a standardized way to identify and isolate the right glissonian sheaths [3]. The intrahepatic approach to glissonian pedicles is a useful step to make easier and safer this formerly complex procedure and permits the complete anatomical delineation of all liver segments [3–6]. This technique allows the removal of individual hepatic segments sparing functioning parenchyma. The authors describe the intrahepatic technique for bi-segmentectomy V-VIII and their experience in eight patients with a small left liver, steathotic liver, or bilateral lesions that otherwise would result in hazardous or extensive liver resection.

This is a report of an initial experience using a recently devised posterior approach to the intrahepatic Glissonian sheaths of the liver, for the purpose of hepatic resections. Between February 1991 and October 1903. 22 patients. median age 58 years (range 36–77) underwent either a right or a left hepatectoiny or a segmentectomy procedure of the liver using this technique. Seventeen of these patients underwent this operation for malignant disease of the liver. Median operating time was 930 min (range 100–285) with nine of the 22 patients requiring an intra-operative blood transfusion. There was one postoperative death, from liver failure, and 17 of the patients were alive at the early time of reporting. It is concluded that this technique is a useful addition to the surgeon's armamentarium for operating on the liver.

Introduction: Laparoscopic liver surgery is being practiced more widely. We would like to report an experience of 170 laparoscopic liver resections. Methods: Data was collected in a prospective fashion from five surgeons, beginning in 1997 with left lateral sectionectomy, and right hepatectomy in 1999. Parenchymal transection was effected with linear cutting staplers, harmonic shears, and most recently, the Ligasure bipolar device. Results: We attempted 27 major resections, 63 sectionectomies, and 80 minor resections. Only rarely were procedures hand-assisted, or “hybrid”. The conversion rate was 8%. Median blood loss was 250 ml. (Range 0–41) Median operative time was 120 minutes. Fifty-one percent of resections were for malignancy. Margins were positive in 5 patients. The overall post operative morbidity was 12%. There were 4 bile leaks. There was one death. Discussion: The indications for surgery should be the same as for open liver resection, however tempting it may be to offer definitive diagnosis by removing peripheral, probably benign, lesions. Approximately 20% of our liver resections are attempted laparoscopically. Most left lateral sectionectomies are performed this way. Major hepatectomies should be attempted only if the tumour is well clear of the plane of transection. Non-anatomic resections require intraoperative ultrasound to ensure adequate margins and to identify large vessels. The ability to suture laparoscopically is essential. Conclusion: The evolving technology of parenchymal transection devices makes laparoscopic liver surgery an exciting frontier. Surgeons must be skilled in open liver surgery and advanced laparoscopy before attempting more than the simplest of procedures.

Purpose Intraoperative blood loss during liver resection remains a major concern due to association with higher postoperative complications. The InLine RFA device (ILRFA) (Resect Medical Inc® Fremont CA) has achieved promising results in liver surgery with minimal blood loss and no increase of postoperative complications. In this multicentre controlled study, 108 patients undergoing liver resection were investigated. Methodology 108 liver resections were performed in 4 medical centres, consisting of 54 ILRFA and 54 ultrasonic Surgical Aspirator (USA) transection as the control group. Pringle manoeuvre was applied only when required. Blood loss was measured from sponge weights and suction bottle contents. Results The type of liver resection was very similar in both groups. Median number of RFA deployments was 3 (1–12) with a median coagulation time of 9 (3–36) minutes. Median operation blood loss was 165 ± 20 ml (5–675 ml) in the ILRFA and 654 +/−83 ml (80–3600 ml) in the control, a 74.8% reduction (P

The use of the CO2 laser in liver surgery is mainly limited by the lack of coagulation of the larger vessels. In an experimental study, partial liver resections were performed on pigs with a Nd:YAG as well as with a combined CO2 and Nd: YAG laser. The best cutting efficiency was obtained with the CO2 laser. On the other hand, the Nd:YAG laser and the combined laser sources showed excellent hemostasis at the cutting edge corresponding with a width of necrosis at about 5 mm in histomorphometric examination and zones with histologically different characteristics. Rebleedings from the resection lines were avoided in all cases using the combined CO2 and Nd:YAG laser.