Foreword

Forty-five years have elapsed since I decided to take up surgery as my professional career after graduation from medical school. I decided to subspecialize in hepato-pancreato-biliary surgery after completing my general surgery training.I then took up an academic post with a noble wish that through basic and clinical researches, I can become a leading surgeon-scientist in liver surgery to fight with my patients against our common enemy called liver cancer, a prevalent and deadly disease in this part of the world.When I started my career in surgery,hepatology was a new branch in Internal Medicine, and liver surgery was still at its infancy. In the 1960s, liver resection was a prohibitive and highly risky endeavor,carried out by a few pioneer surgeons,with inconsistent results. Liver surgery has since developed at a spectacular rate, and it has evolved into a wellplanned and safe procedure. This change has mainly been brought about by the innovative advances made by surgeons based on better understanding of liver anatomy and physiology, appreciation of liver regeneration, and improvements in control of haemorrhage due at least partly to modern technology. The rapid development of liver transplantation from the end of the 1980s has greatly enhanced the experience of surgeons and anaesthetists and enabled the boundaries of liver surgery to be extended. What was previously considered as technically impossible has now become possible. What has been defined as ‘ultra-major’ liver surgery in view of the extent and complexity of the procedure has now been adopted as a routine and carried out in many centers. On the other hand, minimally invasive procedures have also been developed, allowing operations which required a long wound in the past can be done using key-hole incisions. Laparoscopic and robotic liver surgeries are now commonly carried out in centers around the world.

I am extremely fortunate to be involved,at least in part, to the development of this subspecialty of liver surgery at the international, Asia-Pacific and China levels.

With rapid development in liver surgery,there is a high demand on textbooks, not only textbooks covering new knowledge,but also technical skills.

The old operative textbooks describe operations in words. It is not easy for a trainee who has never seen a new operation before to understand how a complicated operation is performed. The next generation of operative textbooks use diagrams to illustrate how an operation is carried out. This results in huge volumes of operative textbooks and yet the Editors have still to choose which operations to include into these books. With advances in technology, it is now possible to combine many videos into a single operative textbook, and liver resection is most suited for such a book.Liver resection is a very complicated procedure which can be carried out with open, laparoscopic or robotic approaches. The liver is divided into 2 hemilivers, 4 sectors, and 8 segments,and each of these units can be resected either alone, or in combination, in a single operation. There are 6 major technical steps in liver resectional surgery, consisting of division of vascular inf low, division of vascular outf low from the right/middle/left hepatic veins and/or the short hepatic veins, transection of hepatic parenchyma, mobilization of liver ligaments, haemostasis on raw liver surfaces and removal of specimens.

Surgeons can use different combinations of sequencing for these major steps to carry out different liver resections. In this new book “Liver Resections by Top Chinese Masters”, we have collected 60 operative videos on liver resection coming from 16 top liver medical centers in China,carried out by 25 surgical masters. The book is divided into 8 chapters which cover topics including liver anatomical structures relevant to liver resection,open/laparoscopic/robotic liver resections on right/left hemihepatectomies, right anterior/right posterior/left lateral/central sectionectomies, caudate lobectomy,isolated liver segment resections,liver resection + portal vein tumour thrombectomy and ALPPS.

This video operative textbook is a must for all surgeons and trainers who wish to embark on open, laparoscopic or robotic liver resections. It is an important textbook for those who wish to improve on their surgical skills in liver resection. Even the most experienced liver surgeons will find this book useful as the videos on liver resections were performed by masters using different instruments, skills and approaches.