Table 6. Summary of consensus statements on Q8 to Q17.
| Spread, difficulty, alternatives |
| Q8: Spread |
| The number of LLRs, laparoscopic liver resection has increased steeply worldwide over the past five years, and published conversion rates have gradually decreased |
| Q9: Difficulty |
| The difficulty of LLR should be estimated by a combination of factors including the extent of liver resection, tumor location, tumor size, proximity to major vessels, and the severity of fibrosis |
| Preoperative estimation of the difficulty of LLR is useful in selecting appropriate patients according to the surgeon’s experience and skill levels |
| Q10: HALS and hybrid |
| Pure LLR, HALS, hand-assisted laparoscopic surgery, and the hybrid method appear equivalent and are a matter of the surgeon’s preference |
| HALS and the hybrid method are used to manage intraoperative difficulties anticipated for pure LLR |
| Techniques |
| Q11: Concept |
| The “caudal” approach is the main conceptual change in LLR, in contrast to the “anterior” approach in OLR, open liver resection |
| The “lateral approach” (left lateral decubitus) gives access to right posterior segments |
| Q12: Bleeding control |
| A temporary increase in CO2 pneumoperitoneum pressure can be used to help control bleeding during LLR |
| Low central venous pressure (<5 mmHg) is recommended during LLR, as in OLR |
| Laparoscopic suturing skills are essential for LLR |
| Q13: Parenchymal transection |
| Currently, several techniques and devices are equivalent for parenchymal transection in LLR and should be left to the surgeon’s preference, as in OLR |
| Q14: Energy devices |
| Various energy devices appear to be equivalent and should be left to the surgeon’s preference and expertise, as in OLR |
| An argon beam coagulator, if used for hemostasis, requires caution to avoid potential gas embolism |
| Q15: Hilar approach |
| Individual hilar dissection and the Glissonian approach appear equivalent and should be left to the surgeon’s preference and expertise, as in OLR |
| Q16: Anatomical resection |
| Anatomical resection for HCC, hepatocelluar carcinoma and parenchyma-sparing strategy for CRLM, colorectal liver metastasis are recommended as in the open approach and require continued evaluation of their application to LLR |
| Simulation, navigation |
| Q17: Simulation and navigation |
| Pre-operative simulation can be useful for measuring the remnant liver volume, visualizing the anatomy and tumor location, and planning the resection plane in selected cases |
LLR, laparoscopic liver resection; HALS, hand-assisted laparoscopic surgery; OLR, open liver resection; HCC, hepatocellular carcinoma; CRLM, colorectal liver metastasis.