FeaturesRecommendations for Laparoscopic Liver Resection A Report From the Second International Consensus Conference Held in MoriokaWakabayashi, Go MD*; Cherqui, Daniel MD†; Geller, David A. MD‡; Buell, Joseph F. MD, MBA§; Kaneko, Hironori MD¶; Han, Ho Seong MD‖; Asbun, Horacio MD**; O'Rourke, Nicholas MD††; Tanabe, Minoru MD‡‡; Koffron, Alan J. MD§§; Tsung, Allan MD¶¶; Soubrane, Olivier MD‖‖; Machado, Marcel Autran MD***; Gayet, Brice MD†††; Troisi, Roberto I. MD‡‡‡; Pessaux, Patrick MD§§§; Van Dam, Ronald M. MD¶¶¶; Scatton, Olivier MD‖‖‖; Hilal, Mohammad Abu MD****; Belli, Giulio MD††††; Kwon, Choon Hyuck David MD‡‡‡‡; Edwin, Bjørn MD§§§§; Choi, Gi Hong MD¶¶¶¶; Aldrighetti, Luca Antonio MD‖‖‖‖; Cai, Xiujun MD*****; Cleary, Sean MD†††††; Chen, Kuo-Hsin MD‡‡‡‡‡; Schön, Michael R. MD§§§§§; Sugioka, Atsushi MD¶¶¶¶¶; Tang, Chung-Ngai MD‖‖‖‖‖; Herman, Paulo MD******; Pekolj, Juan MD††††††; Chen, Xiao-Ping MD‡‡‡‡‡‡; Dagher, Ibrahim MD§§§§§§; Jarnagin, William MD¶¶¶¶¶¶; Yamamoto, Masakazu MD‖‖‖‖‖‖; Strong, Russell MD*******; Jagannath, Palepu MD†††††††; Lo, Chung-Mau MD‡‡‡‡‡‡‡; Clavien, Pierre-Alain MD§§§§§§§; Kokudo, Norihiro MD¶¶¶¶¶¶¶; Barkun, Jeffrey MD‖‖‖‖‖‖‖; Strasberg, Steven M. MD********Author Information *Iwate Medical University, Morioka, Japan †Hepatobiliary Center-Paul Brousse Hospital, Villejuif, France ‡University of Pittsburgh, Pittsburgh, PA §Tulane Transplant Institute, Tulane Medical Center, and Louisiana State University and Medical Center, New Orleans, LA ¶Toho University School of Medicine, Tokyo, Japan ‖Seoul National University Bundang Hospital, Seongnam-si, South Korea **Mayo Clinic, Florida, FL ††Royal Brisbane Hospital, Queensland, Australia ‡‡Tokyo Medical and Dental University, Tokyo, Japan §§Beaumont Health System, Michigan, MI ¶¶University of Pittsburgh Medical Center, Pittsburgh, PA ‖‖Beaujon Hospital, Clichy, France ***Hospital Sirio Libanês, Sao Paulo, Brazil †††Institute Mutualiste Montsouris, France ‡‡‡Ghent University Hospital Medical School, Ghent, Belgium §§§Institut Hospitalo-Universitaire, Strasbourg, France ¶¶¶Maastricht University Medical Center, Maastricht, Netherlands ‖‖‖Pitie-Salpetriere Hospital, Paris, France ****Southampton University Hospital Trust, Hampshire, UK ††††Loreto Nuovo Hospital, Napoli, Italy ‡‡‡‡Sungkyunkwan University, Seoul, South Korea §§§§University of Oslo, Oslo, Norway ¶¶¶¶Yonsei University College of Medicine, Seoul, South Korea ‖‖‖‖San Raffaele Hospital, Milano, Italy *****Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China †††††University of Toronto, Ontario, Canada ‡‡‡‡‡Far-Eastern Memorial Hospital, New Taipei City, Taiwan §§§§§Klinikum Karlsruhe, Karlsruhe, Germany ¶¶¶¶¶Fujita Health University, Aichi, Japan ‖‖‖‖‖Pamela Youde Nethersole Eastern Hospital, Hong Kong, China ******University of Sao Paulo Medical School, Sao Paulo, Brazil ††††††Hospital Italiano Buenos Aires, Argentina ‡‡‡‡‡‡Tongji Hospital, HuaZhong University of Science & Technology, Wuhan, China §§§§§§Paris-South University Hospital, Orsay, France ¶¶¶¶¶¶Memorial Sloan-Kettering Cancer Center, New York, NY ‖‖‖‖‖‖Tokyo Women's Medical University, Tokyo, Japan *******University of Queensland, Queensland, Australia †††††††Lilavati Hospital and Research Centre India, Mumbai, Maharashtra, India ‡‡‡‡‡‡‡The University of Hong Kong, Hong Kong, China §§§§§§§University Hospital Zurich, Zurich, Switzerland ¶¶¶¶¶¶¶The University of Tokyo, Tokyo, Japan ‖‖‖‖‖‖‖McGill University Health Centre and McGill University, Quebec, Canada; and ********Washington University School of Medicine, St Louis, MO. Reprints: Go Wakabayashi, MD, PhD, FACS, Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. E-mail: email@example.com [for queries related to the Expert Technical Section]; Steven M. Strasberg, MD, FACS, FRCS(C), FRCS(Ed), Section of HPB/GI Surgery, Washington University in Saint Louis, 4990 Children's Place, Suite 1160 (Campus Box 8109), St Louis, MO 63110. E-mail: firstname.lastname@example.org [for queries related to the Jury Section]. Disclosure: The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com). Annals of Surgery: April 2015 - Volume 261 - Issue 4 - p 619-629 doi: 10.1097/SLA.0000000000001180 Buy SDC Metrics AbstractIn Brief 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. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014. Clinical questions about outcomes, benefits, and risks were addressed by an independent jury-based consensus model, and technical advances were evaluated on the basis of literature review and expert panel opinion. Recommendations were made regarding value, safety, and techniques of LLR. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.