Pure Laparoscopic Spiegel's Lobectomy for a Case of Colorectal Liver Metastasis in the Caudate Lobe

Abstract

Herein, we describe a case of pure laparoscopic Spiegel's lobectomy performed for a colorectal liver metastasis in the caudate lobe. The patient was an 81-year-old female, who had undergone open colectomy with D3 lymph node dissection for sigmoid colon cancer (T4aN2M0 Stage IIIB) at the age of 80. Nine months after the surgery, her tumor marker level was slightly elevated and CT revealed a mass measuring 18 mm in diameter in the caudate lobe of the liver (Spiegel's lobe). A diagnosis of liver metastasis from sigmoid colon cancer was confirmed, liver resection was scheduled, and pure laparoscopic Spiegel's lobectomy was performed. The operative time was 207 minutes and the operative blood loss was 100 ml. Although isolated caudate lobectomy is a highly difficult surgery because of the anatomical characteristics of the caudate lobe, the magnified caudal view offered by laparoscopy enables safe dissection of the Glissonian pedicles and short hepatic veins during pure laparoscopic Spiegel's lobectomy. Pure laparoscopic Spiegel's lobectomy is a feasible surgical procedure, involving maximal use of the advantages of laparoscopic surgery.