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The e-mémoires of the Académie Nationale de Chirurgie

Precision liver surgery, theory and practice (Présenté en anglais)


Seance of wednesday 27 june 2012 (CHIRURGIE DU FOIE)


The unity of treatment efficacy, surgical safety and minimal invasiveness, has become the core strategy of surgery in the 21st century. In this context, we have been advocating ‘Precision Surgery’, a new surgical concept and model, since 2006, and have been thriving to put it into practice ever since. Precision surgery is characterized by quantification, minimal invasion, visualization, controllability, standardization and aims at multiple-dimensional recovery with minimal surgical invasion, maximizing organ saving and minimal cost-effect ratio. The practice of “Precision Surgery” for the liver is precision liver resection. The Priority of precision hepatectomy is complete removal of the target lesion. Identification of the resection margin is crucial for precision liver resection, which alters with several factors. In the treatment of type IVA BDC, our study showed that at the price of a slightly elevated mortality (but for a benign condition) but a significant increase of morbidity, the short-term (clearance rate of intrahepatic stones) and the long-term results in term of symptoms-free status are significantly improved compared to conventional treatment including extrahepatic cyst excision followed by bilio-digestive anastomosis.The second key point of precision hepatectomy is preservation of the structural integrity and maximized functional volume of the remnant liver. With that in mind, we fostered a Chinese Consensus on the individualized assessment of safety limits for liver resection; while in the protection of Remnant Liver, we emphasize Individualized assessment of functional volume.The third but not the least, efficient control of blood loss and invasiveness. Here I’d like to focus on sharing our experiences in robotic-assisted laparoscopic precise liver resection. Our preliminary results show that robotic-assisted laparoscopic anatomic hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic hepatectomy or open resection.Intervenant: Jacques BAULIEUX