Laparoscopic Left Approach Resection of the Caudate Lobe

Summary

Here, we present a surgical protocol describing the laparoscopic resection of a tumor situated near the paracaval portion within the caudate lobe, utilizing a left-sided approach.

Abstract

Laparoscopic caudate lobectomy (LCL) is one of the most challenging types of laparoscopic liver resections. The main difficulty lies in the deep anatomical position of the caudate lobe, which is closely adjacent to the first and second hepatic ports and the inferior vena cava, increasing the risk of major bleeding during surgery. In addition to a thorough understanding of the anatomy of the caudate lobe tumor, comprehensive imaging assessment, and three-dimensional reconstruction, the flexible choice of surgical approach is also key to reducing surgical difficulty and improving safety. We perform laparoscopic caudate lobectomy using a left-sided approach, especially when the tumor is located in the area of the caudate lobe close to the inferior vena cava. This method avoids the step of splitting the liver substance to expose the field of view required by the traditional anterior approach, with the advantages of larger operating space and shorter operation time. At the same time, combined with preoperative three-dimensional reconstruction technology, we have significantly reduced the risk of damaging important blood vessels and increased the success rate of resection of tumors in the caudate lobe.

Introduction

The caudate lobe is situated deep within the liver, with its specific coverage extending from the front of the inferior vena cava, reaching behind the left, middle, and right hepatic veins, upward to where the three main hepatic veins converge into the inferior vena cava, and downward to the hepatic hilum¹.

Since the pioneering report by Dulucq et al. in 2006 on laparoscopic resections of the hepatic caudate lobe, numerous cases involving isolated resections of the caudate lobe and segmental resections have been documented^2,3,4

Protocol

The surgical procedure received clearance from the Ethics Committee at Zhujiang Hospital, Southern Medical University. Furthermore, the patient and her family provided informed consent for publicly sharing information and data pertinent to the treatment process. This ensures transparency and respects the patient's autonomy in the medical decision-making process.

1. Preoperative preparation

1. Have the patient fast for 8 h and refrain from drinking for 4 h before surgery.
2. Administer general anesthesia and perform endotracheal intubation¹².
   NOTE: Evaluate the effectiveness....

Results

The surgery (Video 1) lasted for 372 min with a blood loss of 300 mL, and no blood transfusion was required. There were five instances of hepatic portal occlusion totaling 70 min. The patient experienced no postoperative complications and had a smooth recovery, staying in the hospital for 8 days post-surgery. Pathological examination indicated focal nodular hyperplasia (FNH) of the liver. The level of bilirubin in the drainage fluid decreased from 30.1 µmol/L on the third postoperative day to 21.4 µmol/L.......

Discussion

The liver is a crucial organ involved in metabolism, immune function, and detoxification¹⁴. Hepatocytes, the liver's primary cells, are typically stable but can become unstable when triggered, initiating the regeneration of liver tissue. Following liver resection, insufficient residual liver volume may lead to severe postoperative complications such as acute liver failure. Thus, rigorous evaluation of liver function post-hepatectomy is of paramount importance^15,

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable hemostat	Ethicon, LLC	W1913T
Disposable spiral negative pressure drainage pipeline	Jiangsu Aiyuan Medical Technology Corp	424280	Drainage of abdominal residual fluid
Disposable trocar	Kangji Medica	10004, 10006
Electrocardiographic monitor	Philips Goldway (SHENZHEN) Industrial, Inc	UT4000B	Postoperative ECG monitoring
Laparoscopic system	Olympus	WM-NP2
Non-absorbable polymer ligation clips (Hem-o-lok)	Teleflex Medical	544230
Ultrasound scalpel	Johnson	GEN11	Tools for liver resection
Vicryl rapide	Ethicon, LLC	3-0, VCP345H 90010	Suture incision and Trocar hole
Video system	Lenovo	GK309