Key operating points of laparoscopic hepatectomy for liver tumor in difficult locations

Laparoscopic hepatectomy has the advantages of little trauma,mild stress response,and rapid postoperative recovery. Due to the deep location and complex structure,tumors located in the upper right posterior areas of the liver( Ⅶ,Ⅷ,and Ⅳa segments) and the caudate lobe have limited surgical field and difficult exposure under laparoscopy,which brings great risk to surgical operation,and these locations are considered difficult locations in laparoscopic liver surgery. In recent years,with the improvement in the technology and concept of laparoscopic liver surgery,the upgrading of surgical instruments and equipment and the application of three-dimensional visualization technology have made it possible to remove liver tumors in difficult locations under laparoscopy. With reference to the authors' own experience,this article summarizes the key technical points of laparoscopic liver surgery in difficult locations,including adequate preoperative assessment,reasonable surgical planning,full exposure of surgical field through body position and trocar distribution,and prediction and prevention of the risk of bleeding. Various new techniques can be used to precisely locate the tumor and guide the partition of liver parenchyma,and with the help of a well-trained surgical anesthesia team,it is possible to ensure the safety and effectiveness of laparoscopic hepatectomy in difficult locations.