Reviewer ’s report  
 
Title: Stapleless laparoscopic left Lateral secti onectom y for hepatocellular carcinoma: 
reappraisal of the Louisville sta tement by a young liver surgeon  
 
Version: 3 Date: 21 Sep 2018  
 
Reviewer: Luca Antonio M. Aldrighetti  
 
Reviewer's report:  
 
The authors intended to explore the results achievable when laparoscopy is applied to patients 
affected by HCC and the liver resection is carried out by a  young surgeon, thus with an 
experience more limited. However, the study design is questionable. It compared the outcomes 
of very different populations: laparoscopic liver resections performed by one single young 
surgeon with different minimally invasive t echniques (pure laparoscopy, robotic, hybrid) and for 
various diagnosis (despite HCC being the most frequent) with traditional open liver resections 
performed by a group of more than one surgeon, all with larger experience. Moreover, also the 
time frame fo r surgery of the two groups was significantly different (laparoscopic: 2012 -2017; 
open: 2009 -2017). Moreover, in the introduction, the authors refer to the first and second 
international consensus on laparoscopic liver surgery, stating their indications. H owever, there 
has been a later and ore recent cornerstone on the applicability of laparoscopy to liver surgery, 
that has produced the first guidelines on laparoscopic liver surgery (PMID: 29064908). This 
document states that "The laparoscopic approach shou ld be recommended as standard practice 
for resection of lesions in the left lateral section and should also be offered to the majority of 
patients undergoing minor liver resection in the anterior segments" with a high level of evidence, 
and no specific exc eption has been raised for HCC. As such, the introduction, aims and 
discussion of the study should be updated and tailored with respect to the existing evidence.  
The English language deserves check from a native speaker. Kaplan Maier curves should include 
number of patients at risk.    
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specif y which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics  in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quali ty of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being pu blished  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years rec eived reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any wa y gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbu rsements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relatio n to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have  no competing interest s' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review po licy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
respons es. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confid ential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Stapleless laparoscopic left Lateral secti onectom y for hepatocellular carcinoma: 
reappraisal of the Louisville sta tement by a young liver surgeon  
 
Version: 3 Date: 21 Sep 2018  
 
Reviewer: Luca Antonio M. Aldrighetti  
 
Reviewer's report:  
 
The authors intended to explore the results achievable when laparoscopy is applied to patients 
affected by HCC and the liver resection is carried out by a  young surgeon, thus with an 
experience more limited. However, the study design is questionable. It compared the outcomes 
of very different populations: laparoscopic liver resections performed by one single young 
surgeon with different minimally invasive t echniques (pure laparoscopy, robotic, hybrid) and for 
various diagnosis (despite HCC being the most frequent) with traditional open liver resections 
performed by a group of more than one surgeon, all with larger experience. Moreover, also the 
time frame fo r surgery of the two groups was significantly different (laparoscopic: 2012 -2017; 
open: 2009 -2017). Moreover, in the introduction, the authors refer to the first and second 
international consensus on laparoscopic liver surgery, stating their indications. H owever, there 
has been a later and ore recent cornerstone on the applicability of laparoscopy to liver surgery, 
that has produced the first guidelines on laparoscopic liver surgery (PMID: 29064908). This 
document states that "The laparoscopic approach shou ld be recommended as standard practice 
for resection of lesions in the left lateral section and should also be offered to the majority of 
patients undergoing minor liver resection in the anterior segments" with a high level of evidence, 
and no specific exc eption has been raised for HCC. As such, the introduction, aims and 
discussion of the study should be updated and tailored with respect to the existing evidence.  
The English language deserves check from a native speaker. Kaplan Maier curves should include 
number of patients at risk.    
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specif y which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics  in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quali ty of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being pu blished  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years rec eived reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any wa y gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbu rsements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relatio n to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have  no competing interest s' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review po licy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
respons es. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confid ential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Stapleless laparoscopic left Lateral secti onectom y for hepatocellular carcinoma: 
reappraisal of the Louisville sta tement by a young liver surgeon  
 
Version: 3 Date: 21 Sep 2018  
 
Reviewer: Luca Antonio M. Aldrighetti  
 
Reviewer's report:  
 
The authors intended to explore the results achievable when laparoscopy is applied to patients 
affected by HCC and the liver resection is carried out by a  young surgeon, thus with an 
experience more limited. However, the study design is questionable. It compared the outcomes 
of very different populations: laparoscopic liver resections performed by one single young 
surgeon with different minimally invasive t echniques (pure laparoscopy, robotic, hybrid) and for 
various diagnosis (despite HCC being the most frequent) with traditional open liver resections 
performed by a group of more than one surgeon, all with larger experience. Moreover, also the 
time frame fo r surgery of the two groups was significantly different (laparoscopic: 2012 -2017; 
open: 2009 -2017). Moreover, in the introduction, the authors refer to the first and second 
international consensus on laparoscopic liver surgery, stating their indications. H owever, there 
has been a later and ore recent cornerstone on the applicability of laparoscopy to liver surgery, 
that has produced the first guidelines on laparoscopic liver surgery (PMID: 29064908). This 
document states that "The laparoscopic approach shou ld be recommended as standard practice 
for resection of lesions in the left lateral section and should also be offered to the majority of 
patients undergoing minor liver resection in the anterior segments" with a high level of evidence, 
and no specific exc eption has been raised for HCC. As such, the introduction, aims and 
discussion of the study should be updated and tailored with respect to the existing evidence.  
The English language deserves check from a native speaker. Kaplan Maier curves should include 
number of patients at risk.    
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specif y which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics  in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quali ty of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being pu blished  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years rec eived reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any wa y gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbu rsements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relatio n to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have  no competing interest s' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review po licy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
respons es. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confid ential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant