As minimally invasive surgery techniques continue to evolve and are increasingly employed in hepatobiliary and pancreatic surgery, ensuring the non-inferiority of these techniques as compared to the gold-standard of open surgery is paramount.

The article by Dili and Bertrand: “ Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy ”, published in the World Journal of Gastroenterology , examines the attributes and limitations of laparoscopic ultrasonography as a method for imaging the bile ducts during laparoscopic cholecystectomy (1).

Since the introduction of laparoscopy as an adjunct to abdominal surgery in the 1980’s, surgeons have sought to compare the clinical outcomes of minimally invasive procedures with their parent operations.

The article entitled “Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy” is an interesting retrospective study from the Johns Hopkins Hospitals Groups reporting clinical and practical risk factors for conversion during distal pancreatectomy.

Despite the many advantages for patients, laparoscopic surgery entails certain ergonomic inconveniences for surgeons, which may result in decreasing the surgeons’ performance and musculoskeletal disorders. In this chapter, the current status of ergonomics in laparoscopy, laparoendoscopic single‐site surgery (LESS), and robot‐assisted surgery will be reviewed. Ergonomic guidelines for laparoscopic surgical practice and methods for ergonomic assessment in surgery will be described. Results will be based on the scientific literature and our experience. Results showed that the surgeon's posture during laparoscopic surgery is mainly affected by the static body postures, the height of the operating table, the design of the surgical instruments, the position of the main screen, and the use of foot pedals. Ergonomics during the laparoscopic surgical practice is related to the level of experience. Better ergonomic conditions entail an improvement in task performance. Laparoscopic instruments with axial handle lead to a more ergonomic posture for the wrist compared to a ring handle. LESS is physically more demanding than conventional and hybrid approaches, requiring greater level of muscular activity in the back and arm muscles, but better wrist position compared with traditional laparoscopy. Physical and cognitive ergonomics with robotic assistance were significantly less challenging when compared to conventional laparoscopic surgery.

Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer-related deaths. Surgery is the only viable treatment, but irradical resection rates are still high. Laparoscopic pancreatic surgery has some technical limitations for surgeons and tumor identification may be challenging. Image-guided techniques provide intraoperative margin assessment and visualization methods, which may be advantageous in guiding the surgeon to achieve curative resections and therefore improve the surgical outcomes. In this chapter, current available laparoscopic surgical approaches and image-guided techniques for pancreatic surgery are reviewed. Surgical outcomes of pancreaticoduodenectomy and distal pancreatectomy performed by laparoscopy, laparoendoscopic single-site surgery (LESS), and robotic surgery are included and analyzed. Besides, image-guided techniques such as intraoperative near-infrared fluorescence imaging and surgical navigation are presented as emerging techniques. Results show that minimally invasive procedures reported a reduction of blood loss, reduced length of hospital stay, and positive resection margins, as well as an improvement in spleenpreserving rates, when compared to open surgery. Studies reported that fluorescenceguided pancreatic surgery might be beneficial in cases where the pancreatic anatomy is difficult to identify. The first approach of a surgical navigation system for guidance during pancreatic resection procedures is presented, combining preoperative images (CT and MRI) with intraoperative laparoscopic ultrasound imaging.

Restoration of bowel continuity after Hartmann’s procedure is considered technically challenging and is associated with high morbidity and mortality. This is the main reason why restoration of intestinal continuity is often not attempted. Over the past decade, considerable international experience has gained on this topic with new minimally invasive techniques being developed. This review details the evolution of minimally invasive techniques in restoration of colonic continuity after Hartmann’s procedure. A comprehensive search of PubMed and Embase was done. Different restoration modalities were included. Eight studies, from six different countries, in which multiport laparoscopic restoration of continuity was compared to conventional open restoration of bowel continuity, were included. In the total of 254 patients, continuity was restored laparoscopically compared with 255 patients in which continuity was performed in open fashion. Restoration of bowel continuity via trephine access was also reported; three studies including 37 patients were included in this review. Single-port restoration of bowel continuity after Hartmann’s procedure is a natural evolution of multiport laparoscopy and trephine access. Six studies reporting on single-port reversal of Hartmann’s procedure were included with a total of 75 patients. Single-port access in combination with a transanal approach has also been reported; however, data are extremely limited as there is only one study in the published literature. Success of restoration of bowel continuity with less morbidity and mortality has been demonstrated throughout the evolution of the different surgical techniques. In this review advantages of different approaches for restoration of bowel continuity after Hartmann’s procedure are discussed. Furthermore, surgical techniques are described, pictorial guides are added for some techniques, and flowcharts are given for easy use during clinical decision-making.

Dear friends, In the last years hepatobiliary and pancreatic laparoscopic surgery have made giant steps forward. Many countries launch national and international prospective databases of LS. The first guideline is now available for laparoscopic liver surgery. In the same way, minimally invasive surgery has grown with many options for surgeons.

Abstract: The aim of this review was to identify the 100 most-cited articles related to laparoscopic liver resection (LLR), to analyze their trend according to publication year and to summarize the knowledge and evidence these one-hundred articles brought to the surgical community. We performed a search to identify all studies dealing with LLR by utilizing the Institute for Scientific Information (ISI) Web of Science (Thomson Reuters, New York, NY, USA) database. We found 2,018 papers, applying the exclusion criteria on all articles, the 100 most cited articles on LLR were identified. The oldest article was published in 1996 and the most recent in 2015. The 100 articles were published in 23 different journals, 55 articles were published in 3 journals: Surgical Endoscopy [27], Annals of Surgery [20] and British Journal of Surgery [8]. The most frequent first and last authors were Dagher I (5 articles) and Cherqui D (7 articles) respectively. In 30 cases the article was published by a French team and in 18 cases from a USA team. Most frequent topics were: hepatocellular carcinoma (17 articles), liver cysts [9], major hepatectomy [8], left lateral resection [7], colorectal metastases [6], benign diseases [4] and living donor hepatectomies [3]. LLR is worldwide performed and surgical indications are expanding.

In the era of minimally invasive surgery, laparoscopy and robotic surgery have to take a role in liver resection. Laparoscopy for liver resection was first documented in the early 1990s, proving to be as safe as conventional open hepatectomy (1,2). During the intervening years, laparoscopic liver surgery series have demonstrated that the laparoscopic approach is associated with a decreased length of hospital stay and decreased estimated blood loss compared to conventional celiotomy (3-5).