The role of minimally invasive surgery in the treatment of polycystic liver disease

Polycystic liver disease (PLD) is an infrequent condition, however cause of significant deterioration of the quality of life of affected patients. Cyst fenestration, liver resection and liver transplantation are effective surgical treatments and apply differently depending on the morphological features of the disease, the clinical presentation and the status of the liver function. During the last 30 years minimally-invasive approaches to surgical procedures have gained popularity, and extended to liver surgery. Laparoscopic cyst fenestrations have spread rapidly as a valid alternative to open for the treatment of PLD with predominant cysts in the anterolateral segment. Laparoscopy may confer several operative advantages for the operating equipe, and favor the postoperative course for patients. However, the adequacy for deeply located cysts or in the postero-superior segments should be studied further, given the increased rate of recurrence. Reports on laparoscopic liver resections for PLD are scant, but suggest the feasibility and safety of these procedures. Efforts should be put collectively to conduct studies aimed to clarify their effectiveness compared to conventional surgery. However, no publications have suggested that PLD is a suboptimal indication or a contraindication for a laparoscopic approach to liver resection. Liver transplantation remains a prerogative of open surgery. Alternative minimally-invasive approaches such as robotics, single-incision laparoscopy and hand-assisted have been applied rarely for PLD. Their added value over pure laparoscopy should be investigated further before promoting their diffusion o