The liver is a vital organ with many functions in relation to metabolism, detoxification, protein biosynthesis, clotting factors, hormone biosynthesis, bile secretion, etc. The anatomy of the liver is complicated which makes surgical procedures performed on it highly demanding. There are various classification systems and variations in terms of anatomy and vascularization. The liver is held in place by a series of ligaments and is roughly divided into the left and the right lobe. Each lobe is further divided into segments (Ι-ΙΧ). The organ receives dual perfusion, from both the portal vein that moves the blood away from the gastrointestinal tract and the hepatic artery. Blood is moved away via the hepatic veins. Bile is secreted via the biliary ducts.
The liver is often the site of primary and metastatic tumors but also the site where other conditions requiring surgical treatment develop such as hydatid cysts.
Laparoscopic surgery contributes to both the diagnosis and treatment of liver conditions. However, the surgeon should be well trained and with extended experience as it presents a high learning curve.
Diagnostic laparoscopy is easy to perform with a small incision on the navel and enables surgeons to identify and biopsize small tumors or hepatic metastases. Laparoscopic ultrasonography contributes to the identification of lesions deep into the hepatic parenchyma, which are not visible on the surface. Radiofrequency ablation (RFA) is another useful application in surgical oncology.
Depending on the localization and extent of the lesion, surgeons are able to perform localized excisions, e.g. excisions of small distal metastases but also larger excisions of liver segments (segmentectomies) and lobe excisions (lobectomies). Preoperative evaluation, specifically in cases of cirrhotic liver, to assess the functionality of the remaining part of the parenchyma is crucial.
Laparoscopic surgery of the liver requires many skills such as being familiar with laparoscopic stapling and ligation, placing clip placement and hemostasis techniques, the use of special apparatus etc. It is, however, associated with lower blood loss, fewer postoperative complications, shorter hospital stay, and faster resumption of everyday activities. It has also been associated with oncological results similar to those achieved with open surgery.