Modified high dorsal procedure for performing isolated anatomic total caudate lobectomy (with video)

Published on Apr 29, 2016in World Journal of Surgical Oncology2.754
· DOI :10.1186/S12957-016-0896-3
Toshiya Ochiai25
Estimated H-index: 25
(Kyoto Prefectural University of Medicine),
Hiromichi Ishii7
Estimated H-index: 7
(Kyoto Prefectural University of Medicine)
+ 5 AuthorsEigo Otsuji59
Estimated H-index: 59
(Kyoto Prefectural University of Medicine)
Background Isolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe. However, isolated caudate lobe resection is a challenging surgical procedure that required safe and reliable techniques. All portal and hepatic veins that connect this area originate from the first branch of the portal vein or vena cava; therefore, the operator must be cautious of the potential for massive bleeding.
#1Xiujun Cai (SRRSH: Sir Run Run Shaw Hospital)H-Index: 30
#2Jie Zhao (SRRSH: Sir Run Run Shaw Hospital)H-Index: 9
Last. Jiang Chen (SRRSH: Sir Run Run Shaw Hospital)H-Index: 17
view all 8 authors...
Abstract Background: Laparoscopic caudate hepatectomy, which is a challenging procedure, has been reported sporadically. However, there is no standardized surgical technique, and the safety and feasibility of this procedure remain controversial. Materials and Methods: A left-sided, purely laparoscopic approach for anatomic caudate hepatectomy was used for 11 selected patients in our institution. The procedure and technique of laparoscopic caudate hepatectomy were described. Perioperative data of...
#1Wei-Dong Dai (CSU: Central South University)H-Index: 6
: Isolated caudate lobectomy for huge hepatocellular carcinoma (HCC) (10 cm or greater in diameter) is a technically demanding surgical procedure that entails the surgeon's experience and precise anatomical knowledge of the liver. We describe our clinical experiences and evaluate the results of partial or total isolated caudate lobectomy for HCC larger than 10 cm in the caudate lobe. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) were excluded. Tw...
#1Hiromichi IshiiH-Index: 7
#2Shinpei OginoH-Index: 5
Last. Toshiya OchiaiH-Index: 25
view all 7 authors...
Background Mesohepatectomy with total resection of the caudate lobe and extrahepatic bile duct is sometimes performed for hilar cholangiocarcinoma or gallbladder carcinoma; however, only a few reports on mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma are available.
#1Yoo Seok Yoon (Seoul National University Bundang Hospital)H-Index: 33
#2Ho-Seong Han (Seoul National University Bundang Hospital)H-Index: 56
Last. Yujin Kwon (Seoul National University Bundang Hospital)H-Index: 5
view all 5 authors...
Background Despite the accumulation of favorable results from laparoscopic liver resection (LLR), centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava (IVC) are still considered contraindications for LLR. We evaluated the feasibility and safety of LLR for centrally located tumors. Methods Of the 182 patients who underwent LLR for benign or malignant tumors between September 2003 and June 2010, the clinical outcomes of 13 patients with tumors within 1 cm or less...
Background The caudate lobe of the liver is located behind both major lobes and is surrounded by the inferior vena cava, three main hepatic veins, and the hepatic hilum. Despite a hard-to-approach anatomic location, isolated complete removal of the caudate lobe is recommended to improve curability in hepatocellular carcinoma (HCC). This is because most patients with HCC cannot undergo caudate lobectomy (segmentectomy 1) with resection of adjacent liver regions due to their poor liver function.
The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. The Glissonean pedicles are wrapped by a connective tissue referred to as the Glisson’s capsule and include the hepatic artery, portal vein and bile duct. The Glissonean pedicles can be approached intrahepatically or extrahepatically. The extrahepatic approach at the hepatic hilus was referred to as the extra-fascial access by Couinaud. In summ...
BACKGROUND: Caudate lobectomy is now considered to be the most appropriate surgical treatment for benign tumors in the caudate lobe. But how to resect the caudate lobe safely is a major challenge to current liver surgery and requires further study. This research aimed to analyze the perioperative factors and explore the surgical technique associated with liver resection in hepatic caudate lobe hemangioma. METHODS: Eleven consecutive patients with symptomatic hepatic hemangiomas undergoing caudat...
#1Norihiro Kokudo (UTokyo: University of Tokyo)H-Index: 6
#2Masatoshi MakuuchiH-Index: 135
The “Clinical Practice Guidelines for Hepatocellular Carcinoma (HCC),” the first evidence-based guidelines for the treatment of HCC in Japan, were compiled by an expert panel supported by the Japanese Ministry of Health, Labour, and Welfare. The English translation has been completed (, and its summary has just been published (Hepatol Res 38:37–51, 2008). This set of guidelines covers six research fields: prevention, diagnosis and surveillance, surgery, chemotherapy, transar...
#1Susumu Eguchi (Nagasaki University)H-Index: 30
#2Takashi Kanematsu (Nagasaki University)H-Index: 58
Last. Kenichi TakayasuH-Index: 58
view all 14 authors...
Background Although a surgical resection is an important modality for the treatment of hepatocellular carcinoma (HCC), the impact of the operative method on both the patient survival and disease-free survival (DFS) still remains controversial. Methods Using a nationwide Japanese database, 72,744 patients with HCC who underwent a curative liver resection between 1994 and 2001 were divided into two groups based on whether an anatomical subsegmentectomy (AS) or a non-anatomical minor hepatectomy (M...
Objectives:To evaluate the prognostic impact of anatomic versus nonanatomic resection on the patients’ survival after resection of a single hepatocellular carcinoma (HCC).Summary of Background Data:Anatomic resection is a reasonable treatment option for HCC; however, its clinical significance remain
Cited By8
#1Tadatoshi Takayama (Nihon University)H-Index: 92
#2Yutaka Midorikawa (Nihon University)H-Index: 31
Last. Masatoshi MakuuchiH-Index: 135
view all 10 authors...
OBJECTIVE: To propose an algorithm for resecting hepatocellular carcinoma (HCC) in the caudate lobe. BACKGROUND: Owing to a deep location, resection of HCC originating in the caudate lobe is challenging, but a plausible guideline enabling safe, curable resection remains unknown. METHODS: We developed an algorithm based on sublocation or size of the tumor and liver function to guide the optimal procedure for resecting HCC in the caudate lobe, consisting of 3 portions (Spiegel, process, and caval)...
BACKGROUND The caudate lobe is located deep in the dorsal portion of the liver. Complete resection is an extremely demanding surgery due to the limited surgical field, especially in cases with severe intra-abdominal complications. A major concern of isolated caudate lobectomy is the difficulty associated with securing the contralateral visual field during parenchymal transection. To overcome this issue, we present a new technique for isolated caudate lobectomy that uses a modified hanging maneuv...
Abstract Background To demonstrate the surgical procedures and techniques of the robotic anatomical isolated complete caudate lobectomy. Methods A retrospective analysis was performed on the demographic, operative, postoperative outcomes of seven patients who underwent robotic anatomical isolated complete caudate lobectomy at our department from January 2018 to November 2019. Mobilization of the left lateral and Spiegel lobe, dissection of the short hepatic veins and liver parenchyma transection...
#1Jian Cong Chen (SYSU: Sun Yat-sen University)H-Index: 6
#2Chun Yu Huang (SYSU: Sun Yat-sen University)H-Index: 1
Last. Zhongguo Zhou (SYSU: Sun Yat-sen University)H-Index: 14
view all 7 authors...
AbstractBackground: Hepatic caudate lobectomy is considered to be a technically difficult surgery because of the unique anatomy and deep location of the hepatic caudate lobe. Here, we assessed the technical feasibility and safety of robotic partial caudate lobectomy using the da Vinci® Surgical System and compared it with traditional open/laparoscopic surgery.Material and methods: Six patients diagnosed with liver cancer (primary liver cancer, 5; metastasis of breast cancer, 1) who underwent cau...
#1Ji-Xiong Hu (CSU: Central South University)H-Index: 7
#2Wei-Dong Dai (CSU: Central South University)H-Index: 6
Last. Tenglong Tang (CSU: Central South University)
view all 4 authors...
The caudate lobe lies between major vascular structures: the inferior vena cava posteriorly and the portal triad inferiorly and the right and the middle and left hepatic veins at the upper part [1]. Couinaud’s definition of the caudate lobe is based on morphological segmentation but not on portal perfusion. Thus, Kumon’s definition of the caudate lobe was widely accepted and applied, in which the caudate lobe was divided into three parts: the Spiegel lobe, paracaval portion, and caudate process ...
#1Tokio Higaki (Nihon University)H-Index: 12
#2Tadatoshi Takayama (Nihon University)H-Index: 92
Last. Yutaka Midorikawa (Nihon University)H-Index: 31
view all 3 authors...
Abstract Background Resection of hepatocellular carcinoma located in the caudate lobe is challenging because this anatomical location is difficult to approach, especially the caval portion. Methods We performed resection of the caval portion of the caudate lobe using a ventral approach combined with the resection of segment IV, VII, or VIII for hepatocellular carcinoma in 41 patients (extended segmentectomy group). As a control group, 138 patients with hepatocellular carcinoma who underwent segm...
#1Kit Man Ho (Seoul National University Bundang Hospital)H-Index: 2
#2Ho-Seong Han (Seoul National University Bundang Hospital)H-Index: 56
Last. Jang Kyu Choi (Seoul National University Bundang Hospital)H-Index: 5
view all 9 authors...
Abstract Background: The caudate lobe consists of the Spigelian lobe, paracaval portion, and the caudate process. It is in proximity to the right and middle hepatic veins, the inferior vena cava (IVC) posteriorly, and the portal triad anteriorly. Torrential bleeding can occur from the IVC and the short hepatic veins during dissection. There are few small case series on laparoscopic caudate lobectomy,1–7 many of which are on limited resection or combined resection with other lobes. Isolated total...
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