Liver surgery continues to evolve, as knowledge of liver anatomy and physiology deepens, new technologies are introduced, and the experience of surgical teams increases. Internationally, liver surgery is part of a very well-defined subspecialty today, namely "hepato-biliary-pancreatic surgery". The United States has a two-year post-residency training system (Fellowship). Europe has an examination organized by UEMS in which candidates must demonstrate specific training in one or more HPB units. A two-year training certificate in hepato-biliary-pancreatic surgery was introduced in Romania, coordinated by three centers: Fundeni Clinical Institute in Bucharest, Sfantul Spiridon Hospital in Iasi and Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca. The first two centers also provide training for liver transplantation. This special issue primarily reflects the experience of these three centers, to which are added newer ones, under development. One of these new centers (the Surgical Department II "Sf. Maria" Hospital in Bucharest), represented by C. Stroescu et al, presents a valuable experience in HPB surgery accumulated in the last 7 years. The importance of anatomy in liver surgery is underlined by the work of L. Simion et al, which analyzes the anatomical variants of the hepatic artery and their importance in resection and transplant surgery. Current liver surgery necessarily involves intraoperative ultrasound, which is highlighted in the excellent review by A. Bartos et al in the particular case of resections for hepatocellular carcinoma. Also, the importance of this exploration results from the experience of liver resections for metastases of stromal gastrointestinal tumors (GIST) analyzed by A. Kraft et al. An important advance in liver surgery was the minimally invasive, laparoscopic or robotic approach. M. Marino et al. present an interesting experience in robotic liver surgery. Among the other topics addressed, we retain the method called ALPPS (Associating liver partition and portal vein ligation for staged hepatectomy). Viewed with reservations at first and even met with severe criticism, ALPPS seems to have prevailed now, the results being considered convincing by most authors. This is reflected in two articles: A review article by F. Botea et al based also on an important experience both in Fundeni Hospital, but mainly in the Department of Surgery in Zurich and Kiel. The personal experience of A. Hotineanu et al. We were honored to include this article from the Republic of Moldova, especially since there is still a close connection between the surgery center at the Republican Hospital in Chisinau and the Romanian surgery. The progress made in liver transplantation is reflected in the work of Nicolaescu et al on the experience of Fundeni center in hypothermic mechanical oxygenated perfusion of liver grafts, one of the most important developments in transplantation in recent years, which contributed significantly to the continuous improvement of postoperative results. Hydatid cyst surgery could not be missed, in a country where this pathology is still widespread enough. The work of C. Molnar et al addresses a complicated form of the disease, namely multiple hydatid cyst. This special issue covers also the topic of interventional treatment, in the article of Lupascu et al about the percutaneous drainage of liver abscess. Two of the works are dedicated to bile duct surgery: A. Bartos at al. presents the personal experience on portojejunostomy in cases of complex lesions of the extrahepatic bile duct; R. Popescu et al. presents the personal experience on the management of residual gallbladder and cystic duct stump stone after cholecystectomy. The video presentations bring a special added value in a difficult and spectacular surgery, not without risks. It is worth noting first of all the video with the resection of a giant hepatic artery aneurysm (V. Brasoveanu et al), as well as the two films of complex ultrasound- guided resections of F. Botea et al. I am convinced that the video of M. Marino et al on robotic left hemihepatectomy will surely be very much appreciated by the readers of Chirurgia.
Celsius.