Surgical technique: new advancements for expanding indications and safety: the Western experience.

The technical issues discussed herein represent part of the panorama of innovative approaches proposed for the surgical treatment of hepatocellular carcinoma (HCC); in particular, the attention is focused on the recent advances in the field of planning the surgical strategy and performing liver dissection via ultrasound guidance. It is described how recent technical advances have allowed the range of scenarios for which surgery is indicated in liver cirrhosis patients with HCC to be widened. Indeed, the ability to spare the liver parenchyma with respect to liver inflow and outflow and its biliary drainage as well as to perform the anatomic removal of subsegmental portions of the liver has enabled surgeons to provide new therapeutic horizons, and will probably result in modifications to the therapeutic flow charts of HCC patients once the new horizons are fully accepted by nonsurgical specialists devoted to the treatment of these complex patients.