Recommendations for Laparoscopic Liver Resection A Report From the Second International Consensus Conference Held in Morioka

Go Wakabayashi*, Daniel Cherqui, David A. Geller, Joseph E. Buell, Hironori Kaneko, Ho Seong Han, Horacio Asbun, Nicholas O'Rourke, Minoru Tanabe, Alan J. Koffron, Allan Tsung, Olivier Soubrane, Marcel Autran Machado, Brice Gayet, Roberto I. Troisi, Patrick Pessaux, Ronald M. Van Dam, Olivier Scatton, Mohammad Abu Hilal, Giulio BelliChoon Hyuck David Kwon, Bjorn Edwin, Gi Hong Choi, Luca Antonio Aldrighetti, Xiujun Cai, Sean Clemy, Kuo-Hsin Chen, Michael R. Schoen, Atsushi Sugioka, Chung-Ngai Tang, Paulo Herman, Juan Pekolj, Xiao-Ping Chen, Ibrahim Dagher, William Jarnagin, Masakazu Yamamoto, Russell Strong, Palepu Jagannath, Chung-Mau Lo, Pierre-Alain Clavien, Norihiro Kokudo, Jeffrey Barkun, Steven M. Strasberg

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.
Original languageEnglish
Pages (from-to)619-629
JournalAnnals of Surgery
Issue number4
Publication statusPublished - Apr 2015


  • anatomical resection
  • colorectal liver metastasis
  • donor hepatectomy
  • hepatocellular carcinoma
  • liver resection
  • laparoscopic
  • pneumoperitoneum
  • robotic


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