日本腹腔镜肝切除术的进展与挑战

Advancements and challenges in laparoscopic hepatectomy in Japan

摘要:

在21世纪10年代，腹腔镜肝切除术（LH）作为一种微创肝切除方法，在日本迅速获得了广泛应用。其显著优势包括减少术后疼痛和更快的恢复时间。LH中使用的Glissonean蒂入路，有助于精确的解剖性切除，尤其适用于肝细胞癌和转移性肝肿瘤。在培训方面的创新，如动物模型的使用和日本内镜外科学会认证项目，对提升外科医生的技术水平起到了关键作用。然而，涉及血管或胆道重建的复杂肝切除术仍面临较大的技术挑战。机器人辅助手术（RAH）在提高精确度和可视化方面展现出巨大的潜力，但其高昂的成本和不确定的长期效益限制了其广泛应用。未来需要进一步的技术进步、强化培训项目以及大规模的对比试验，以评估LH和RAH的长期疗效。

Abstract:

In the 2010s, laparoscopic hepatectomy (LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections. It offers significant advantages, such as reduced postoperative pain and faster recovery. The Glissonean pedicle approach, employed during LH, enables precise anatomical resection, particularly for hepatocellular carcinoma and metastatic liver tumors. Innovations in training, including the use of animal models and the Japan Society for Endoscopic Surgery certification program, have been instrumental in improving surgical expertise. However, complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges. Robot-assisted hepatectomy (RAH) has shown great potential for improved precision and visualization, though its high costs and uncertain long-term benefits limit its widespread adoption. Further technological advancements, enhanced training programs, and large-scale comparative trials are necessary to evaluate the long-term efficacy of both LH and RAH.