Transhepatic Approach for Laparoscopic Caudate Lobectomy

Abstract

Very few studies have focused on laparoscopic caudate lobectomy. We report a case of hepatocellular carcinoma in the caudate lobe that was resected by laparoscopic caudate lobectomy using a transhepatic approach. A 60-year-old man with a history of chronic hepatitis B was referred to our hospital for evaluation. Angio CT revealed a 2.7×2.5 cm tumor in the paracaval portion of the caudate lobe. Clinical and image findings led to a diagnosis of hepatocellular carcinoma. Laparoscopic caudate lobectomy using a transhepatic approach was performed. Laparoscopic surgery was performed in the left lateral decubitus position and six trocars were inserted. After mobilization of left and right lobes of the liver, short hepatic veins and inferior right hepatic vein were resected. First, liver resection was performed along the Cantlie line, exposing the right and dorsal side of the middle hepatic vein. Then, liver resection was performed toward the Arantius duct. Second, liver resection was performed, exposing the left and dorsal side of the right hepatic vein. Glisson’s sheaths of the caudate lobe were resected at the porta hepatis. Third, liver resection was performed along the demarcation line at the right edge of the caudate lobe. Finally, hepatocytes between the paracaval portion of the caudate lobe and posterior segment of the right lobe were resected, and the specimen was resected. We selected laparoscopic surgery, because it is possible to perform sophisticated procedures due to the enlarged view.