Surgical Techniques for Totally Laparoscopic Caudate Lobectomy

Objectives: The purpose of this study is to identify the safety and feasibility of laparoscopic caudate lobectomy. Background: Caudate lobectomy has been considered as technically difficult because of the deep location of the caudate lobe and its proximity to great vessels. Due to the technical difficulty, laparoscopic caudate lobectomy was not feasible in patients with malignancy in the caudate lobe. Methods: Six consecutive patients with caudate hepatic malignancy received laparoscopic caudate lobectomy at Samsung Medical Center from September 2007 to May 2014. Demographic data, intraoperative parameters, and postoperative outcomes were assessed. Results: All procedures for these 6 patients with caudate malignancy were completed with totally laparoscopic technique. Only 1 patient who had hepatocellular carcinoma in the Spiegel lobe underwent partial caudate lobectomy, and others underwent complete caudate lobectomy. The mean tumor size was 2.65 cm (range 0.9–5.1 cm). The mean operative time was 382 minutes (range 168–615 minutes) and none required transfusion. The mean duration of hospital stay was 8 days (range 6–13 days). There was no perioperative complication and patient mortality in this series. The resected margins of the specimens were tumor free (R0 resections, range 0.1–1.2 cm). The mean follow-up period was 56 months (range 12.9–93.7 months). No patient died during the follow-up period. Conclusions: Our experience demonstrated that laparoscopic caudate lobectomy is safe and feasible in selected patients with malignancy in the caudate lobe.