Technical notes on pure laparoscopic isolated caudate lobectomy for patient with liver cancer

Background: The advantages of laparoscopic liver resection become more obvious as evidence on its long-term outcome has emerged. Compared to open resection, there is no difference in term of overall survival. Many reports showed that the hospital stay was shorter and blood loss was less when laparoscopic hepatectomy was used. However, laparoscopic approach for caudate lobe resection remains a challenging procedure. The close proximity to inferior vena cava (IVC) and hepatic vein make this procedure extra difficult. This paper will demonstrate the use of pure laparoscopic approach for a patient with caudate lobe liver metastasis. Haemostasis by intracorporal suturing is safely performed when bleeding is encountered from the IVC. Method: The patient was a 54-year-old lady who had carcinoma of the rectum with laparoscopic anterior resection performed. She was found to have a 2 cm lesion in the left caudate lobe of the liver on follow-up. Her platelet count was only 120x10(9)/L. Pure laparoscopic resection of the caudate lobe was performed as shown in the video. Results: The operation last for 180 minutes. Blood loss was 220 mL and no blood transfusion was required. She resumed diet on the next day and was discharged 3 days after the operation. Histopathological examination showed 2 cm colorectal liver metastasis with a clear margin. Contrast CT scan performed 1 year after the operation showed no recurrence of the disease. Conclusions: Laparoscopic approach for caudate lobe resection is a feasible option. It can be performed to patients in center by surgeons with experience in both hepatobiliary and laparoscopic skills.