Laparoscopic liver resection in patients with clinically significant cirrhosis: an Eastern perspective

A sick heart can be revascularized, improving the health of the entire body. The function of a diseased kidney can be substituted by a dialysis machine. Just the act of cutting the abdominal wall can lead to death in a patient with underlying liver disease. And that the ducts and vessels of the liver are hidden from plain sight, have slowed the application of laparoscopy to liver surgery. As Dr. Blake Cady elegantly said nearly two decades ago: “Biology is King; selection of cases is Queen, and the technical details of surgical procedures are the Princes and Princesses of the realm who frequently try to overthrow the powerful forces of the King or Queen, usually to no long-term avail, although with some temporary apparent victories.” As commendable as the effort in pushing technical boundaries by the HPB surgical community is, we must not forget that these pursuits must translate to improving survival and quality of life. It just may be that laparoscopic liver resection (LLR) produces a greater balance between the king and the queen.