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Liver surgery remains the gold standard for the treatment of liver tumours. To aid with hepatic resection, several devices have been developed in an attempt to stem significant blood loss and reduce the necessity for vascular exclusion. Of note are the Harmonic scalpel, bipolar scissors, hydrodissectors, Ligasure diathermy, Cavitron ultrasonic aspirator (CUSA) and Monopolar floating ball. However, most of these devices still require some degree of vascular inflow occlusion or are time consuming and none, except radiofrequency, can also be used to successfully ablate tumours. Furthermore, vascular occlusion- whether it is intermittent, continuous, partial or total- affects postoperative function of the hepatic remnant, especially in those patients treated with neo-adjuvant chemotherapy or in those patients with underlying chronic liver disease. Of all the new techniques now being applied to liver surgery the most successful and versatile is radiofrequency, which, until recently, was used only for in situ ablation of unresectable tumours

The role of liver resection for benign and malignant hepatobiliary diseases is expanding, because of the markedly reduced operative mortality in recent years, as the result of better patient selection, improved surgical techniques and better perioperative management. The major technical challenge of liver resection is control of bleeding during transection of the parenchyma. Liver resection can be performed by different transection devices with or without inflow occlusion (Pringle manoeuvre). Only limited data is available on the best transection technique. The most popular devices facilitating bloodless transection include the ultrasonic dessicator (e.g: Cavitron Ultarsonic Surgical Aspirator (CUSA), Tyco Healthcare, Mansfield, MA), water jet dissector [1] (e.g: Hydro-jet, Erbe, Tubingen, Germany), harmonic scalpel, mono and bipolar cautery devices, and the dissecting sealer (e.g: Tissuelink, Dover, NH0) [2]. Parenchymal dissection has been performed under routine inflow occlusion with finger fracture technique (digitoclasy), where liver parenchyma is crushed between finger and thumb, isolating vessels and bile ducts, which then can be ligated and divided

Advancement in radiological imaging technique has been crucial in the development of most of the surgical fields. Planning for operations needs good visualization of the organ and localization of the lesion within it, which was possible by Computed Tomography (CT) & Magnetic Resonance Imaging (MRI). However, without knowledge of major blood vessels or other important structures related to the lesion, surgery cannot be performed curatively and safely at the same time. In neurosurgery, this fact has been early recognized and three-dimensional (3D) imaging technique widely adopted to increase accuracy of the procedures. Similarly, reconstructed 3D images have been very useful in orthopaedic and maxillofacial surgery as well [1]

The gene therapy dream started well over a decade ago. Despite its wide and successful application in research, it still has not reached the clinics in a meaningful way. No doubt that successful gene therapy has a lot to offer to patients with inherited, benign or malignant diseases

Despite improvements in the management of liver tumours, both primary and metastatic, these tumours are still considered one of the most common malignancies worldwide with a high mortality rate and disappointing long-term survival rates. Hepatic resection has become the standard modality of treatment for patients with liver tumours, and currently remains the only potentially curative therapy. Many factors can affect hepatectomy, such as tumour size, location, multifocality, patients’ status, and hepatic function. But in order to attain a tumour free margin extensive hepatectomy is often necessary, which has led to an increased survival and improved outcome after hepatic resection for liver tumours: colorectal metastases [1, 2], hilar cholangiocarcinoma [3, 4] and hepatocellular carcinoma [5, 6, 7]

Over the past twenty-five years, hepatic resection has evolved from a high risk, resource intensive procedure with limited application to a safe and commonly performed operation, with broad indications. This period has seen dramatic improvement in perioperative outcome, including reductions in mortality, blood loss, transfusion rates, and hospital stay [1]–[2]. These improved perioperative results are largely responsible for the emergence of hepatic resection as a viable and effective treatment option for selected patients with 1 and 2 hepatobiliary malignancy. Continued advances in imaging technology, along with a heightened awareness of the clinical and tumour-related variables that dictate outcome, have allowed better preoperative assessment of disease extent and improved patient selection. Advances in other areas, such as minimally invasive and ablative techniques, have increased the treatment options and have had some impact on the approach to patients with malignant hepatobiliary disease. However, resection remains the most effective therapy

Surgical advances generally follow either a scientific discovery or a technological breakthrough, for example magnetic resonance imaging or joint replacement. Over the past few years, the advent of new energy sources, such as radiofrequency, has had an increasing impact on surgical practice, especially in the field of liver tumours. Liver resection presently offers the only opportunity for cure in patients with liver cancer, either primary or secondary. Unfortunately, most hepatic cancers are unsuitable for curative resection at the time of diagnosis. Limitations for surgical resection can broadly be classified as either: 1) tumour-related, i.e. lesions that are extremely large, awkwardly sited, multiple, involving major vascular structures, associated with extrahepatic disease or 2) patient-related, i.e. intercurrent medical conditions, old age and poor liver function, especially in those with underlying cirrhosis. Therefore, there is a clear need, for the development of a simple and effective technique to control unresectable tumours within the liver and, preferably, one that avoids a lengthy hos pital stay in patients with limited duration of survival. In the past few years, minimal access has beco me available for the destruction of hepatic carcinomas by methods such as ethanol injection and thermoablation, with cryoprobes, laser or radiofrequency

Those diseases which medicines do not cure, iron (the knife?) cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable