Robotic isolated partial and complete hepatic caudate lobectomy:A single institution experience

Background:Current reports on robotic hepatic caudate lobectomy are limited to Spiegel lobectomy.This study aimed to compare the safety and feasibility of robotic isolated partial and complete hepatic caudate lobectomy.Methods:Clinical data of 32 patients who underwent robotic resection of the hepatic caudate lobe in our department from May 2016 to January 2020 were retrospectively analyzed.The patients were divided into three groups according to the lobectomy location:left dorsal segment lobectomy(Spiegel lobectomy),right dorsal segment lobectomy(caudate process or paracaval portion lobectomy),and complete caudate lobectomy.General information and perioperative results of the three groups were compared and analyzed.Results:Among the 32 patients,none had conversion to laparotomy,three received intraoperative blood transfusion(9.38%),and none had complications of Clavien-Dindo gradeⅢor higher or died in the perioperative period.Among them,17 patients(53.13%)underwent Spiegel lobectomy,7(21.88%)underwent caudate process or paracaval portion lobectomy,and 8(25.00%)underwent complete caudate lobectomy.The operative time and blood loss in the left dorsal segment lobectomy group were significantly better than those in the right dorsal segment lobectomy and complete caudate lobectomy groups(operative time:P=0.010 and P=0.005;blood loss:P=0.005 and P=0.017,respectively).The postoperative hospital stay in the left dorsal segment lobectomy group was significantly shorter than that in the complete caudate lobectomy group(P=0.003);however,there was no difference in the postoperative hospital stay between the left dorsal segment lobectomy group and right dorsal segment lobectomy group(P=0.240).Conclusions:Robotic isolated partial and complete caudate lobectomy is safe and feasible.Spiegel lobectomy is relatively straightforward and suitable for beginners.

Giant hemangioma of the caudate lobe of the liver with surgical treatment:A case report

BACKGROUND Caudate lobe hemangioma of the liver is relatively rare.Due to the unique anatomical location of the caudate lobe,the caudate lobectomy accounts for only 0.5%to 4%of hepatic resection,which is difficult to operate and takes a long time,and even has many postoperative complications.CASE SUMMARY A 34-year-old female presented with a 1 year history of intermittent pain in the right side of the waist without obvious inducement.All laboratory blood tests were within normal limits.Indocyanine green 15 min retention was rated 2.9%,and Child-Pugh was rated A.Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe with hemangioma of left lobe of liver.After discussion,surgical treatment was performed,which lasted 410 min,with intraoperative bleeding of about 600 mL and postoperative pathological findings of cavernous hemangioma.There were no obvious postoperative complications,and the patient was discharged 10 d after surgery.CONCLUSION Caudate lobectomy is difficult due to its special anatomical location.Under the condition of fully exposing the anatomy of the first porta hepatis,the second porta hepatis,the third porta hepatis,the fourth porta hepatis and middle hepatic vein and combining with the Pringle maneuver,caudate lobectomy can be performed in a precise and safe process.

Resection of hepatic caudate lobe hemangioma:experience with 11 patients

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 caudate lobectomy from November 1990 to August 2009 at our hospital were investigated retrospectively. All patients were followed up to the present. RESULTS: In this series, 9 were subjected to isolated caudate lobectomy and 2 to additional caudate lobectomy (in addition to left lobe and right lobe resection, respectively). The average maximum diameter of tumors was 9.65+/-4.11 cm. The average operative time was 232.73+/-72.16 minutes. Five of the 11 patients required transfusion of blood or blood products during surgery. Ascites occurred in I patient, pleural effusion in the perioperative period in 1, and multiple organ failure in 1 on the 6th day after operation as a result of massive intraoperative blood loss, who had received multiple transcatheter hepatic arterial embolization preoperatively. The alternating left-right-left approach produced the best results for caudate lobe surgery in most of our cases. All patients who recovered from the operation are living well and asymptomatic. CONCLUSIONS: For large hemangioma of the caudate lobe, surgery is only recommended for symptomatic cases. Caudate lobectomy of hepatic hemangioma can be performed safely, provided it is carried out with optimized perioperative management and innovative surgical technique.

Precautions in caudate lobe resection: Report of 11 cases

AIM： To find the precautions against the safety in caudate lobe resection. METHODS： The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe： （1） selection of appropriate skin incision to obtain excellent exposure of operative field; （2） adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; （3） preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; （4） selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate Iobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate Iobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral Iobectomy for 2 cases and caudate Iobectomy alone for 6 cases. RESULTS： Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation. CONCLUSION： Caudate Iobectomy for liver cancer in candate lobe can be safely performed with the above procedures.

Early control of short hepatic portal veins in isolated or combined hepatic caudate lobectomy

BACKGROUND:Caudate lobectomy has long been considered technically difficult.This study aimed to elaborate the significance of early control of short hepatic portal veins(SHPVs) in isolated hepatic caudate lobectomy or in hepatic caudate lobectomy combined with major partial hepatectomy,and to describe the anatomical characteristics of SHPVs.METHODS:The data of 117 patients who underwent either isolated or combined caudate lobectomy by the same team of surgeons from 2005 to 2009 were retrospectively analyzed.From 2005 to 2007(group A,n=55),we carried out early control of short hepatic veins(SHVs) only;from 2008 to 2009(group B,n=62),we carried out early control of both SHVs and SHPVs.The two groups were compared to evaluate which surgical procedure was better.A detailed anatomical study was then carried out on the last 25 consecutive patients in group B to study the number and distribution of SHPVs during surgery.RESULTS:Patients in group B had less intra-operative blood loss,less impairment of liver function,shorter postoperative hospital stay,fewer postoperative complications and required less blood transfusion(P<0.05).The number of SHPVs in the 25 patients was 183,with 7.3±2.7 per patient.The diameters of SHPVs were 1 to 4 mm.On average,3.4 SHPVs/patient came from the left portal vein,2.2 from the bifurcation,1.4 from the right portal vein,and 0.3 from the main portal vein.On average,3.3 SHPVs/patient supplied segment I of the liver,0.4 for segment II,2.1 for segment IV,1.4 for segment V and 0.1 for segment VI.CONCLUSION:Early control of SHPVs in isolated or combined hepatic caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery.

Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe:Isolated or combined lobectomy?

AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.

Abscess of the caudate lobe of the liver, a rare disease with a challenging management: a case report

We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in plan- ning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyo- genic liver abscess, but is it applicable also for caudate lobe abscess？

Anterior transhepatic approach for total caudate lobectomy including spigelian lobe,paracaval portion and caudate process:A Brazilian experience

To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar cholangiocarcinoma.Since the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular

Sectional anatomy of the caudate lobe of liver:based on coronal and sagittal sections

To provide practical and surgical anatomy for the imaging diagnosis and surgical treatment of the disease of the caudate lobe of the liver. Methods： Based on Chinese Visible Human 1-5 data sets and assisted by 3D visualization and reconstruction, the 3D models of the upper abdomen or the liver were reconstructed and the cross-sectional images were converted to the coronal and sagittal images. The anatomy of the caudate lobe of the liver on the coronal and sagittal planes was investigated on serial planes of the upper abdomen. Results： The caudate lobe was bordered on the left by the fissura ligamenti venosi, posteriorly by the IVC, superiorly by the hepatic veins and inferiorly by the hepatic hilum. Its right and ventral borders might be obscure, with only relative borders existent. The right wall of the IVC was a good landmark to judge the relative realm of paracaval portion, and the relative ventral plane might exist between the hepatic hilum and entrance of hepatic veins. The caudate lobe could be divided into two principal regions： the left Spiegel lobe and the right paracaval portion. The caudate process, and the right rear process occurring in some individuals belonged to the right paracaval portion. The caudate lobe was blood supplied by the portal vein, which directly drained into the IVC. Conclusion： There are not definite borders for the right part of the caudate lobe, and most of the knowledge on it is based on the cast study, which may not suit for the clinical diagnosis and practice. The coronal and sagittal sections can better show the anatomic relationships between the caudate lobe, the other parts of the liver and the adjacent structures. The 3D digital visualization is an accurate and convenient study method for clinical anatomy.

Transarterial chemoembolization vs. liver resection as initial treatment for hepatocellular carcinoma occurring exclusively in caudate lobe: A retrospective propensity matching analysis

Treatment of hepatocellular carcinoma(HCC)in the caudate lobe is technically challenging.This retrospective study was designed to evaluate the clinical outcome of both superselective transcatheter arterial chemoembolization(TACE)and liver resection(LR)for HCC occurring exclusively in the caudate lobe.From January 2008 to September 2021,a total of 129 patients were diagnosed with HCC of the caudate lobe.The Cox proportional hazard model was used to analyze the potential clinical factors and established prognostic nomograms with interval validation.Of the total number of patients,78 received TACE and 51 received LR.The overall survival(OS)rates(TACE vs.LR)at 1,2,3,4,and 5 years were 83.9%vs.71.0%;74.2%vs.61.3%;58.1%vs.48.4%;45.2%vs.45.2%;and 32.3%vs.25.0%,respectively.However,subgroup analysis revealed that TACE was superior to LR for treating patients with stage IIb Chinese liver cancer(CNLC-IIb)in the entire cohort(p=0.002).Interestingly,no difference was found between TACE and LR in the treatment outcomes of CNLC-IIa HCC(p=0.6).Based on Child-Pugh A and B calculations,TACE tended to lead to a better OS than LR(p=0.081 and 0.16,respectively).Multivariate analysis showed that Child-Pugh score,CNLC stage,ascites,alpha fetoprotein(AFP),tumor size,and anti-HCV are related to OS.Predictive nomograms for 1,2,and 3 years were performed.Based on this study,TACE may provide a longer OS than liver resection for patients with CNLC-IIb HCC of the caudate lobe.Because this suggestion is limited by the study design and relatively small sample size,additional randomized controlled trials are needed.

Isolated laparoscopic resection of the hepatic caudate lobe

The caudate lobe （Couinaud＇s segment 1） is located at the posterior part of the liver. Isolated resection of caudate lobe is a major challenge especially when it is carried out laparoscopically. We report a case of successful total laparoscopic resection of caudate lobe using the technique of curettage and aspiration on a hepatic hemangioma which measured 7 cm ×5 cm. As far as we know, this is the first report from Asia on isolated laparoscopic resection of the hepatic caudate lobe.

Successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments

BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.METHODS A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years(21-56 years)with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019.The surgical methods included total pericystectomy,segmental hepatectomy,or hemihepatectomy.RESULTS Among the 5 patients,4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis,all of whom underwent robotic radical operation successfully without conversion to laparotomy.Total caudate lobectomy was performed in 2 cases,hepatectomy of segment Ⅶ in 1 case,total pericystectomy of segment Ⅷ in 1 case,and right hemihepatectomy in 1 case.Operation time was 225 min(175-300 min);blood loss was 100 mL(50-600 mL);and postoperative hospital stay duration was 10 d(5-19 d).The Clavien-Dindo complication grade was Ⅰ in 4 cases and Ⅱ in 1 case.No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.CONCLUSION Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.

Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma

The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional(3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In thisreport, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.

Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging:A case report

BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract.Esophageal-lodged foreign bodies can cause secondary injury or detrimental response,with hepatic abscess being one such,albeit rare,outcome.Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever.Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver(7.8 cm×6.0 cm×5.0 cm).Initially,a malignant tumor was suspected,but differential diagnosis was unable to exclude the possibility of hepatic abscess.Conservative anti-infection therapy produced a less than ideal outcome.Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess,and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb.Therefore,surgery was performed to remove the object(fishbone)and drain the abscess.After a 2-wk uneventful recovery,the patient was discharged.The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.CONCLUSION Differential diagnosis is important for hepatic masses,and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.

Primary squamous cell carcinoma of the liver:A case report

BACKGROUND Squamous cell carcinoma(SCC)of the liver is rare,and is more commonly found in the skin,rectum,cervical or inguinal lymph nodes.CASE SUMMARY A 73-year-old man had been experiencing right upper quadrant discomfort for some weeks.He had a 50-year history of smoking and drinking.On average,he smoked 20 cigarettes and consumed 200 galcoholdaily.He didn’t have a history of hepatitis or surgery.Fever,vomiting,jaundice,dysuria,chills,and abdominal distention were not observed at the time of admission.Tenderness in the right upper quadrant was found on physical examination,but there was no palpable abdominal mass.No obvious abnormalities in laboratory tests and tumor markers were found.The plasma retention rate of indocyanine green(ICG)at 15 min was 1.35%.Subsequent abdominal ultrasonography showed a mixed echoic mass approximately 3.8 cm diameter in the left caudate lobe of the liver.Abdominal computed tomography confirmed a 3.0 cm×3.5 cm irregular mass with inhomogeneous density and moderate delayed enhancement in the left caudate lobe of the liver.Laparoscopic left caudate lobectomy was performed to remove the liver mass.Intra-operative findings confirmed a non-cirrhotic liver,with a 3 cm×3.5 cm white tumor mass in the left caudate lobe with no tumor rupture and no hemoperitoneum.The resection margin was 1.0 cm in width.CONCLUSION We describe the first case of SCC in the left caudate lobe of the liver,which was successfully treated by surgical resection and postoperative immunotherapy.No tumor recurrence was observed during the 8-mo follow-up.