Indications include superficial benign tumors less than 5 cm in diameter, superficial malignant tumors less than 3 cm in diameter or multiple malignant tumors in an area less than 3 cm in depth requiring local resection of tumors or segmentectomy, peripheral lesions (segments VI, VII) of intrahepatic stones with irreversible diseases (biliary strictures or severe parenchymal fibrosis or atrophy) requiring segmentectomy, and liver function of Child A to B. Contraindications include malignant tumors involving porta hepatis (PH) or close to major vessels or hepatic ducts (HDs), history of biliary surgeries such as exploration of the common bile duct (CBD) or cholangiojejunostomy (cholecystectomy is not regarded as a contraindication), extrahepatic bile duct stricture, or acute suppurative cholangitis.

Patients are placed in the supine position under general anesthesia. Three surgeons are needed in the operation. The senior surgeon stands on the left side of the patient, one assistant surgeon stands on the right side of the senior surgeon controlling the aspiration device, and the other assistant surgeon stands on the right side of the patient. Four entries are made. A supraumbilical 10-mm trocar is inserted as the observation port. A 12-mm trocar is inserted below the xiphoid as the main manipulation port for right liver lesions or is inserted below the left costal margin for left liver lesions. And two 5-mm trocars are inserted at the right flank area as assistant manipulation ports (Fig. 7.1).

See Figs. 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9, 7.10, 7.11, 7.12, 7.13, 7.14, 7.15, 7.16, 7.17, 7.18, 7.19, 7.20, 7.21, 7.22, 7.23, 7.24, 7.25, 7.26, 7.27, 7.28, 7.29, and 7.30.