Isolated laparoscopic resection of the hepatic caudate lobe: surgical technique and a report of 2 cases.

The caudate lobe of the liver, segment 1 (S1), is located between the hepatic hilum and the inferior vena cava. Resection of S1 alone, without sacrificing other parts of the liver, is a surgical challenge. We present 2 cases of isolated laparoscopic resections of hepatic S1. We are the first to describe this laparoscopic technique. Two patients affected by colorectal liver metastases confined to S1 underwent laparoscopic isolated resections of S1 using a left approach. One of them also underwent left lateral segmentectomy. Both interventions were accomplished laparoscopically without conversion. Operative time for the first patient was 150 minutes and that for the second patient was 105 minutes. Blood loss was 200 and 100 mL for the first and second patients, respectively. There were no major intraoperative complications except for a tear in the inferior vena cava in the first patient that was repaired without the need for conversion. The postoperative course was uneventful for both patients. The duration of hospital stay was 10 and 8 days, respectively. The resected margins of the specimens were tumor-free (R0 resections). The 2 patients are alive and disease-free 7 and 5 months after the procedure. Isolated laparoscopic resection of the hepatic caudate lobe can be performed by a highly skilled surgeon, but should be performed only in selected cases.