Isolated complete caudate lobectomy for hepatic tumor of the anterior transhepatic approach: surgical approaches and per
- PDF / 512,081 Bytes
- 6 Pages / 595.28 x 793.7 pts Page_size
- 78 Downloads / 185 Views
CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Isolated complete caudate lobectomy for hepatic tumor of the anterior transhepatic approach: surgical approaches and perioperative outcomes Jia-Hua Yang1,3, Jun Gu1, Ping Dong1, Lei Chen1, Wen-Guang Wu1, Jia-Sheng Mu1, Mao-Lan Li1, Xiang-Song Wu1, Yang-Lu Zhao2, Lin Zhang1, Hao Weng1, Qian Ding1, Qi-Chen Ding1 and Ying-Bin Liu1*
Abstract Background: How to resect the caudate lobe safely is a major challenge to current liver surgery which requires further study. Methods: Nine cases (6 hepatic cell carcinoma, 2 cavernous hemangioma and 1 intrahepatic cholangiocacinoma) were performed using the anterior transhepatic approach in the isolated complete caudate lobe resection. During the operation, we used the following techniques: the intraoperative routine use of Peng’s multifunction operative dissector (PMOD), inflow and outflow of hepatic blood control, low central venous pressure and selective use of liver hanging maneuver. Results: There were no perioperative deaths observed after the operation. The median operating time was 230 ± 43.6 minutes, the median intraoperative blood loss was 606.6 ± 266.3 ml and the median length of postoperative hospital stay was 12.6 ± 2.9 days. The incidence of complications was 22.22% (2/9). Conclusion: PMOD and “curettage and aspiration” technique can be of great help of in the dissection of vessels and parenchyma, clearly making caudate lobe resection safer, easier and faster.
Background The caudate lobe, which is generally divided into three regions: the left Spiegel’s portion, the process portion, and the paracaval portion, is located in a complex anatomical position, deep behind the confluence of the main hepatic veins, porta hepatis and inferior vena [1]. In other words, it is surrounded by three portae hepatis. The blood supply and biliary drainage of the caudate lobe come from both the left and the right portal triads, called the caudate portal triads (CPT). However, the number of triads may vary. Venous drainage (short hepatic vein) occurs along its posterior aspect directly into the inferior vena cava (IVC) through several small branches of variable size and location. Biliary drainage includes small tributaries to the right but occurs predominantly through the left hepatic duct.
Due to the deep location and position between the major vascular structures, the caudate lobe has been always considered a forbidden area for hepatic surgery, and its resection is always a challenge for hepatobiliary surgeons. However, with solid knowledge of the anatomical relationship, mastery of the appropriate surgical instrument and thorough experience of performing the operation, the caudate lobectomy can be carried out safely. Isolated complete caudate lobectomy is the most difficult and most complex of the various methods of caudate lobe resection [2]. The anterior transhepatic approach for isolated complete caudate lobe resection has been carried out in our department. In this article, it is proved to be safe, effective and clin
Data Loading...
