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20.10.2015 | Ausgabe 7/2016

Surgical Endoscopy 7/2016

Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study

Surgical Endoscopy > Ausgabe 7/2016
Taizo Hibi, Daniel Cherqui, David A. Geller, Osamu Itano, Yuko Kitagawa, Go Wakabayashi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-015-4586-y) contains supplementary material, which is available to authorized users.
Presented at the Second International Consensus Conference on Laparoscopic Liver Resection, Morioka, Japan, October 2014.



Laparoscopic liver resection (LLR) has undergone widespread dissemination after the first international consensus conference in 2008, and specialized centers continue to report remarkable achievements. However, little is known about the global adoption of LLR. This study aimed to illuminate geographical variances in the indications and technical aspects of LLR and to delineate the evolution of this approach worldwide.


In advance of the Second International Consensus Conference in Morioka, Japan, a web-based, anonymous questionnaire comprising 46 questions, named the International Survey on Technical Aspects of Laparoscopic Liver Resection study, was sent via e-mail to the members of regional and International Hepato-Pancreato-Biliary Association offices. The results of the 13 questions concerning the global diffusion of LLR have been reported previously. Responses to the remaining 33 questions that corresponded to indications and surgical techniques used in LLR were collected and analyzed.


Survey responses were received from 412 LLR surgeons in 42 countries on five continents. The majority of surgeons in North America had no restrictions on the maximum size or number of tumors to be resected laparoscopically. Likewise, >50 % of surgeons in East Asia and North America performed LLR for the postero-superior ‘difficult’ segments. Major resection was performed in 40 to >60 % of centers in North America, Europe, and East Asia. Donor hepatectomy was performed only in specialized centers. More than 75 % of respondents had adopted a pure laparoscopic approach. A flexible laparoscope was most commonly used in East Asia. Most surgeons used pneumoperitoneal pressure at around 9–16 mmHg. Other techniques and devices were used at the discretion of each surgeon.


Indications for LLR continue to expand with some regional diversity. Surgical approaches and devices used in LLR are a matter of preference and availability, as in open liver resection.

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Supplementary material Fig. A. Use of the indocyanine green clearance test for laparoscopic liver resection. (JPEG 54 kb)
Supplementary material Fig. B. Increase in robotic approach over the past 5 years (2009–2013). (JPEG 57 kb)
Supplementary material Fig. C. Increased level of pneumoperitoneal pressure at the time of bleeding. (JPEG 68 kb)
Supplementary material Fig. D. Use of intraoperative ultrasound. (JPEG 32 kb)
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