Minimally invasive liver and biliary procedures

Abstract

Minimally invasive techniques have been applied to hepatobiliary surgery more frequently as comfort with and understanding of hepatobiliary surgery has grown. The goal is to technically perform the case as if it is an open procedure while taking advantage of the benefits minimally invasive surgery can bring, including decreased post-operative pain, time of ileus, and length of stay, as well as improved cosmesis. Techniques for minimally invasive hepatobiliary surgery include pure laparoscopic, hand-assisted laparoscopic, the hybrid approach (operation is started laparoscopically for mobilization of the liver and early dissection and followed by a small laparotomy for completion of the hepatic parenchymal transection], and more recently robotic-assisted. The following chapter describes minimally invasive techniques used for common hepatobiliary procedures. The illustrations and pictures that follow are adapted from a combination of laparoscopic, hand-assisted, and robotic-assisted cases, but note that regardless of the minimally invasive technology used, the approach and technique remain essentially the same.