Junichi Shindoh1, Hiroshi Imamura, Norihiro Kokudo. 1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. shindou-tky@umin.ac.jp
Abstract
BACKGROUND/ PURPOSE: The Spiegel lobe is located deep in the dorsal portion of the liver, and isolated resections of this region are technically demanding, especially in bulky and/or invasive lesions or in hypertrophied cirrhotic livers. METHODS: Anterior approach using the isolated hanging maneuver of the Spiegel lobe was attempted in patients in whom the conventional method of mobilizing the Spiegel lobe prior to liver transection would have been difficult. Clinical outcomes were compared with the conventional approach performed during the same period. RESULTS: Of 42 consecutive isolated resections of the Spiegel lobe, the presently reported technique was required in 12 patients (28.6%). The median diameter of the tumors was 33 mm, and tumor invasion to the retrohepatic inferior vena cava was observed in four patients. Although minor vascular injury was observed in one patient during retrohepatic dissection, the isolated sling suspension of the Spiegel lobe was successfully conducted in all cases. No remarkable inferiority of the present technique compared with the conventional approach was noted either in operation data or clinical outcomes. CONCLUSION: Anterior approach using the isolated sling-suspension technique may be a safe alternative surgical option for bulky and/or invasive lesions located in the Spiegel lobe of the liver.
BACKGROUND/ PURPOSE: The Spiegel lobe is located deep in the dorsal portion of the liver, and isolated resections of this region are technically demanding, especially in bulky and/or invasive lesions or in hypertrophied cirrhotic livers. METHODS: Anterior approach using the isolated hanging maneuver of the Spiegel lobe was attempted in patients in whom the conventional method of mobilizing the Spiegel lobe prior to liver transection would have been difficult. Clinical outcomes were compared with the conventional approach performed during the same period. RESULTS: Of 42 consecutive isolated resections of the Spiegel lobe, the presently reported technique was required in 12 patients (28.6%). The median diameter of the tumors was 33 mm, and tumor invasion to the retrohepatic inferior vena cava was observed in four patients. Although minor vascular injury was observed in one patient during retrohepatic dissection, the isolated sling suspension of the Spiegel lobe was successfully conducted in all cases. No remarkable inferiority of the present technique compared with the conventional approach was noted either in operation data or clinical outcomes. CONCLUSION: Anterior approach using the isolated sling-suspension technique may be a safe alternative surgical option for bulky and/or invasive lesions located in the Spiegel lobe of the liver.