Laparoscopic resection of liver tumors

Laparoscopic liver resection is technically challenging compared to open liver surgery and has a steep learning curve. Tumors located in the posterior sector, centrally, in proximity of major vascular pedicles or in a background of liver cirrhosis are surgically more complex with a higher risk of blood loss. There is emerging consensus about indications for laparoscopic liver resection. While laparoscopic approach is considered standard for left lateral sectionectomy and minor laparoscopic liver resections in antero-lateral segments, with increasing experience, major resections, parenchyma sparing resections and even donor hepatectomies are being performed laparoscopically with good outcomes. Laparoscopic liver surgery is feasible and safe for well selected patients by well-trained surgeons with short-term advantages and non-inferior long-term oncologic outcomes

Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation:Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Small-for-size syndrome (SFSS) following living donor liver transplantation is a complication that can lead to devastating outcomes such as prolonged poor graft function and possibly graft loss. Because of the concern about the syndrome, some transplants of mismatched grafts may not be performed. Portal hyperperfusion of a small graft and hyperdynamic splanchnic circulation are recognized as main pathogenic factors for the syndrome. Management of established SFSS is guided by the severity of the presentation with the initial focus on pharmacological therapy to modulate portal flow and provide supportive care to the patient with the goal of facilitating graft regeneration and recovery. When medical management fails or condition progresses with impending dysfunction or even liver failure, interventional radiology (IR) and/or surgical interventions to reduce portal overperfusion should be considered. Although most patients have good outcomes with medical, IR, and/or surgical management that allow graft regeneration, the risk of graft loss increases dramatically in the setting of bilirubin &gt;10 mg/dL and INR&gt;1.6 on postoperative day 7 or isolated bilirubin &gt;20 mg/dL on postoperative day 14. Retransplantation should be considered based on the overall clinical situation and the above postoperative laboratory parameters. The following recommendations focus on medical and IR/surgical management of SFSS as well as considerations and timing of retransplantation when other therapies fail.</p