Recent advances and difficulties in techniques of the complex and extended liver resection       CHEN Xiao-ping, HE Song-qing. Hepatic Surgery Center，Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan430030, China
Abstract    Advances in liver surgery have increased the safety of all types of liver resections and have made complex and extended hepatectomy performed successfully with low operative mortality. The progresses achieved are attributable to an improved understanding of hepatic anatomy using computer-aided reconstruction of the tumor zones,vascular and biliary anatomy, intraoperative ultrasound and other new imaging technologies and a better method of vascular clamping, vascular reconstruction and better techniques and instruments to achieve more precise liver transection with a good haemostasis on the cut surface. Preoperative manipulation of the liver volume with hypertrophy of the future liver remnant (portal vein embolization) has made complex and extended hepatectomies feasible. Control bleeding during hepatic resection using low CVP anesthesia with selective vascular inflow and outflow control before parenchymal transection is a safe, reliable and effective approach. Complex combinations of surgery, chemotherapy and local ablation are used in advanced disease, extended the limits of resectability for liver tumors. Hepatic laparoscopic surgery is gaining popularity due to the useful for staging purposes and the availability of new laparoscopic instruments for liver transection. Advances in laparoscopic equipment and techniques and telerobotic surgery will undoubtedly expand the use of the techniques and become the next frontier in hepatic complex resectional surgery.