Dong Kuiran.Recent advances of minimally invasive liver surgery in children[J].Journal of Clinical Pediatric Surgery,,():1006-1010.[doi:10.3760/cma.j.cn101785-202508008-002]
Recent advances of minimally invasive liver surgery in children
- Keywords:
- Liver; Minimally Invasive Surgical Procedures; Child
- Abstract:
- Recent years have seen rapid advancements in minimally invasive liver surgery (MIS) for children.And laparoscopic liver resection (LLR) and robotic liver resection (RLR) are becoming mainstream.As compared to open surgery,MIS may significantly reduce volume of intraoperative blood loss,shorten hospitalization stay and lower complication rates,making it ideal for children.RLR offers superior visual clarity,instrument flexibility and operational stability over LLR,especially during complex hepatic segment resections.Auxiliary techniques of indocyanine green (ICG) fluorescent imaging,liver hanging maneuver (LHM),portal vein embolization (PVE) and three dimensional (3D) visualization have further enhanced surgical safety and precision.Despite these advances,various challenges remain,including limited long-term oncological outcome data,difficulties of standardizing techniques and cost-effectiveness concerns.Future efforts should focus upon structured training systems,broader adoption of these technologies and a sound integration of artificial intelligence and personalized therapies.
References:
[1] 段怡涛, 郑百俊, 高亚, 等.小儿腹腔镜下肝切除术4例[J]. 临床小儿外科杂志, 2013, 12(2): 110-112, 119. DOI: 10.3969/j.issn.1671-6353.2013.02.010. Duan YT, Zheng BJ, Gao Y, et al.Laparoscopic liver resection in children:a report of 4 cases[J]. J Clin Ped Sur, 2013, 12(2): 110-112, 119. DOI: 10.3969/j.issn.1671-6353.2013.02.010.
[2] Abu Hilal M, Hoogteijling TJ, Edwin B, et al.The Brescia internationally validated European guidelines on minimally invasive liver surgery[J]. Br J Surg, 2025, 112(6): znaf113. DOI: 10.1093/bjs/znaf113.
[3] Masuda T, Endo Y, Nakamura S, et al.Short-term outcomes of laparoscopic central hepatectomy:a comparison with open surgery[J]. Langenbecks Arch Surg, 2025, 410(1): 78. DOI: 10.1007/s00423-025-03645-4.
[4] Téoule P, Dunker N, G lz V, et al.What matters in laparoscopic hepatectomy for lesions located in posterosuperior segments? Initial experiences and analysis of risk factors for postoperative complications:a retrospective cohort study[J]. Surg Endosc, 2025, 39(6): 3691-3701. DOI: 10.1007/s00464-025-11674-9.
[5] 彭宇明, 尹强, 盛新仪, 等.3D腹腔镜下前入路经肝正中裂劈开儿童肝尾状叶肿瘤切除术[J]. 临床小儿外科杂志, 2020, 19(11): 1007-1011. DOI: 10.3969/j.issn.1671-6353.2020.11.009. Peng YM, Yin Q, Sheng XY, et al.Three-dimensional laparoscopic resection of caudate lobe hepatic tumor via an anterior approach in children[J]. DOI: 10.3969/j.issn.1671-6353.2020.11.009.
[6] Bernardi L, Balzano E, Roesel R, et al.Recurrence and survival after robotic vs laparoscopic liver resection in very-early to early-stage (BCLC 0-A) hepatocellular carcinoma[J]. Surg Endosc, 2025, 39(3): 2116-2128. DOI: 10.1007/s00464-025-11553-3.
[7] Haugen C, Noriega M, Andy C, et al.Complete transition from laparoscopic to robotic liver surgery achieves superior outcomes in difficult hepatectomies:a seven-year retrospective study[J]. Surg Endosc, 2025, 39(3): 1600-1608. DOI: 10.1007/s00464-024-11474-7.
[8] Wang YC, Lu SL, Tan XL, et al.Liver resection in stage 0-A HCC in segments 7/8:a propensity-matched analysis comparing open, laparoscopic, and robotic approach[J]. Surg Endosc, 2025, 39(3): 1902-1914. DOI: 10.1007/s00464-024-11521-3.
[9] 郑百俊, 程继文, 高亚, 等.腹腔镜肝切除术与开腹肝切除术治疗肝母细胞瘤的临床效果比较[J]. 临床小儿外科杂志, 2019, 18(11): 935-940. DOI: 10.3969/j.issn.1671-6353.2019.11.008. Zheng BJ, Cheng JW, Gao Y, et al.Safety, feasibility and short-term outcome of laparoscopic liver resection versus open liver resection for hepatoblastoma[J]. J Clin Ped Sur, 2019, 18(11): 935-940. DOI: 10.3969/j.issn.1671-6353.2019.11.008.
[10] 姚伟, 董岿然.荧光引导技术在儿童肿瘤手术中的应用及展望[J]. 临床小儿外科杂志, 2021, 20(10): 906-910. DOI: 10.12260/lcxewkzz.2021.10.002. Yao W, Dong KR.Current applications and future prospects of fluorescence guided surgery for pediatric tumors[J]. J Clin Ped Sur, 2021, 20(10): 906-910. DOI: 10.12260/lcxewkzz.2021.10.002.
[11] Franz M, Arend J, Bollensdorf A, et al.The impact of indocyanine green on tumor visualization and procedural adjustment in minimally invasive liver surgery[J]. Langenbecks Arch Surg, 2025, 410(1): 143. DOI: 10.1007/s00423-025-03712-w.
[12] Huerta M, Dalmau M, Fernandes N, et al.Brightening the path to safe liver transplants:the role of ICG fluorescence in biliary anastomosis[J]. BMJ Surg Interv Health Technol, 2025, 7(1): e000322. DOI: 10.1136/bmjsit-2024-000322.
[13] Avella P, Spiezia S, Rotondo M, et al.Real-time navigation in liver surgery through indocyanine green fluorescence:an updated analysis of worldwide protocols and applications[J]. Cancers (Basel), 2025, 17(5): 872. DOI: 10.3390/cancers17050872.
[14] Gigola F, Bici K, Morabito A, et al.The pediatric surgeon’s perspective on the liver hanging maneuver:a case report and literature review[J]. Front Pediatr, 2025, 13:1536755. DOI: 10.3389/fped.2025.1536755.
[15] Wildhaber BE, Terraz S.Portal vein embolization in children:as good as ALPPS[J]. Ann Hepatobiliary Pancreat Surg, 2021, 25(2): 313-314. DOI: 10.14701/ahbps.2021.25.2.313.
[16] Dong Q, Xiu WL, Tang BJ, et al.International multidisciplinary consensus recommendations on clinical application of three-dimensional visualization in precision surgery for pediatric liver tumors[J]. HPB (Oxford), 2025, 27(6): 733-745. DOI: 10.1016/j.hpb.2025.03.007.
[17] Di Fabrizio D, Bindi E, Nino FB, et al.The use of robotic single site system in pediatric surgery:a systematic review[J]. J Robot Surg, 2025, 19(1): 192. DOI: 10.1007/s11701-025-02276-7.
[18] Cazares J, Koga H, Yamataka A.Advances in the surgical technique of Kasai portoenterostomy[J]. Semin Pediatr Surg, 2024, 33(6): 151481. DOI: 10.1016/j.sempedsurg.2025.151481.
[19] Ota K, Tainaka T, Hinoki A, et al.Young pediatric surgeons without endoscopic surgical skill qualification safely perform advanced endoscopic surgery under the supervision of expert qualified surgeons[J]. Surg Endosc, 2025, 39(5): 2925-2930. DOI: 10.1007/s00464-025-11657-w.
[20] Pilz da Cunha G, Hoogteijling TJ, Besselink MG, et al.Robotic versus laparoscopic liver resection:a systematic review and meta-analysis of comparative studies[J]. Int J Surg, 2025, 111(8): 5549-5571. DOI: 10.1097/JS9.0000000000002567.
[21] Tang R, Qi SQ, Zhang T, et al.Progress in the study of therapeutic strategies for hepatoblastoma in children[J]. World J Gastrointest Oncol, 2025, 17(6): 107700. DOI: 10.4251/wjgo.v17.i6.107700.
Memo
收稿日期:2025-8-4。
基金项目:唐仲英基金会(ZSBK0070)
通讯作者:董岿然，Email:kuirand@fudan.edu.cn