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It is my great honor and privilege to write an Editorial on this special issue of Updates in Surgery focused on ‘‘Minimally Invasive Liver Surgery: an up-to-date.’’ One of the Editors-in-Chief, Professor Fulvio Calise, kindly asked me to contribute to this issue. I know he has dedicated many efforts to promote the diffusion of minimally invasive liver surgery in Italy, including the foundation of the Italian Group of Minimally Invasive Liver Surgery (I Go MILS) with Professor Luca Aldrighetti (I Go MILS–President) and Professor Giulio Belli (I Go MILS—Vice President, It. Chapter IHPBA—President). Both are the Expert panels of the 2nd International Consensus Conference on Laparoscopic Liver Resection (ICCLLR) held on October 4–6, 2014, in Morioka, Iwate Prefecture, Japan. The ICCLLR in Morioka was held in an effort to better define the current role of laparoscopic liver resection (LLR) and to develop internationally accepted guidelines [1]. The organizing committee (Table 1) applied an independent jury-based consensus model to achieve this goal through analysis of the available literature with presentations including videos by Expert panels in front of Jury panels [2]. We all know that the level of evidence is low in the field of LLR to create strong recommendations. Therefore, we tried to be fair to draw the consensus statements under the judge by Jury. Table 1 shows the panels of the ICCLLR, and 43 respected surgeons, i.e., 34 expert panelists plus nine jury members not directly involved in LLR, were invited from 18 countries. Table 2 summarizes 17 clinical questions (CQs) related to the value and techniques of LLR, and 17 working groups assigned to answer these 17 questions by extensive literature reviews. The jury provided recommendations on CQ 1–7, which were related to benefits and risks of LLR [1]. However, the experts provided recommendations on CQ 8–17, which were related to technical aspects of LLR [1]. Expert consensus statements on CQ 8–17 were created from expert presentations, assessment of the literature, and experience on individual techniques. One of the major achievements of the ICCLLR was that all international experts were present in the same room at the same time. These are technical recommendations from experts that will never be proved by level 1 evidence and still need to be shared so that the beginners can benefit from the expert learning curve. Another major achievement of the ICCLLR is publications of related activity to the ICCLLR [3–7] and the systematic reviews that were prepared to create recommendations before the ICCLLR [8– 14]. A couple of more manuscripts are now under review to be published. A comprehensive literature review was performed, and analysis was done using multiple case series, case–control studies, reviews, and meta-analysis published over the last several years. It is our hope that all these publications from the ICCLLR will contribute to the steady and safe spread of LLR. During the 6 years between the 1st International Consensus Conference on Laparoscopic Liver Resection in Louisville and the ICCLLR in Morioka, this comparatively new surgical technique has evolved and is rapidly being adopted worldwide (Table 3). In my opinion, LLR is superior to open liver resection (OLR) because the laparoscope allows better exposure with a magnified view, and the pneumoperitoneal pressure reduces hepatic vein bleeding from the cut surface [4]. The concept for liver & Go Wakabayashi go324@mac.com

From Louisville to Morioka: where is now MILS?