There is an increasing number of reports regarding the safety and efficacy of operative procedures of laparoscopic liver resection (LLR). Safety is the primary concern regarding the introduction of LLR; therefore, guidelines are needed for that purpose. In the Second International Consensus Conference for Laparoscopic Liver Resection, held in Morioka in 2014, we proposed a novel scoring system of surgical difficulty on the basis of liver functional reserve and tumor factors, including tumor location and relationship to major vessels in an attempt to serve as a guideline for training. Our difficulty scoring system has been validated to correlate with surgical outcome in the clinical setting. A step-by-step training system appropriate for the difficulty score and individual surgical skill can lead to safe expansion of the indication of LLR.
Japan Society for Endoscopic Surgery created “Endoscopic Surgical Skill Qualification System”. In order to master a stable LLR, every trainee has to learn the basic techniques of port site design, and how to use energy devices and control bleeding. In this lecture, such fundamental techniques of LLR and our current efforts to disseminate safe LLR will be presented. In addition, further advanced technique, including anatomical liver resection and reduced-port liver resection will be shown.