We thank Dr. Giovinazzo and Dr. Sutcliffe for their thoughtful comments regarding our systematic review on laparoscopic parenchymal-sparing hepatectomies (LPSH) (1). The meta-analysis of the current literature demonstrated that LPSH was feasible with perioperative outcomes comparable to previously published data on open parenchymal sparing hepatectomy (PSH), however mostly in the setting of solitary liver tumors (2). We made clear in our paper that the main limitations of the study are (I) the

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... election bias as the analysis is based only on retrospective studies, and also (II) the relative lack of data regarding LPSH for more than one lesion and bi-lobar disease. It is acknowledged that laparoscopic liver resections for tumors in the posterosuperior segments and with multicentric disease are technically more challenging (3). These limitations are currently being investigated by a variety of prospective trials, i.e., the Orange posteriorsuperior segment trial. The systematic review was performed to draw attention to this novel species of liver resection LPSH and describe its technical infancy. We agree with Giovinazzo and Sutcliffe that the definition of LPSH used is quite preliminary. Not every non-anatomical resection is per se a PSH. Any resection becomes a PSH by the fact that an anatomical resection of "more" liver tissue could be considered a "reasonable" but less optimal alternative in 2020 by most experts. PSH will need to be defined as we go, and the definition will change as time passes and skills in LPSH improve. No doubt, only an operational definition will allow Letter to the Editor