J.Jpn. Surg. Soc.. 116(5): 302-306, 2015

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Feature topic

CURRENT STATUS AND FUTURE PROSPECTS OF LAPAROSCOPIC HEPATOBILIARY-PANCREATIC SURGERY

Laparoscopic hepatobiliary-pancreatic surgery (L-HPB), excluding cholecystectomy, is a highly specialized field. However, important technological developments and improved endoscopic procedures are being established. Thus, the number of L-HPB procedures has been increasing. Recent systematic reviews or meta-analyses based on observational data have reported not only the advantage of less invasiveness in early disease stages but also less bleeding, fewer complications, and no oncologic disadvantage, although prospective, randomized trials have not yet been performed. L-HPB is expected to develop further in the future as a new surgical method to improve patients' quality of life. While it is certain that L-HBP surgery will not totally supplant open HBP surgery, the laparoscopic approach in selected patients should be considered as the treatment of choice. However, it must be remembered that the benefits of L-pancreatic duodenectomy as well as liver resection should be balanced against the high degree of difficulty. Robotic-assisted L-HBP is expected to support difficult operative procedures by allowing more precise hand manipulations, although a greater accumulation of clinical cases is needed to evaluate this. The success of L-HBP is affected by individual surgeons' learning curves and the selection of patients with appropriate indications. The basic principle of L-HBP as well as other digestive surgery is to achieve minimal invasion with optimal safety.

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