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Step-by-step isolated resection of segment 1 of the liver using the hanging maneuver

https://doi.org/10.1016/j.amjsurg.2009.02.012Get rights and content

Abstract

The caudate lobe can be the origin of primary liver tumours or the sole site of liver metastases. This lobe is anatomically divided into 3 parts: Spiegel's lobe (Couinaud's segment 1), paracaval portion (Couinaud's segment 9), and the caudate process. In this series of 4 cases, we provide a step-by-step description of a surgical technique variation that can be applied to resections of lesions localized in segment 1. We believe that other than size, lesion removal in this hepatic anatomic area, which is difficult to perform, can be done more easily using this new approach because it requires minimal mobilization without unnecessary parenchyma transection of other liver parts. Therefore, it reduces the risk of lesions in the inferior vena cava and the middle hepatic vein and respects adequate margins without the use of clamping maneuvers and in an acceptable surgical time.

Section snippets

Surgical anatomy

For surgical anatomy purposes, the caudate lobe is considered to have 2 parts: Spiegel's lobe (Couinaud's segment 1) on the left and the paracaval portion (Couinaud's segment 9) on the right, which includes the caudate process (Fig 1A). Both parts are anatomically divided by a deep notch in 50% of individuals. In addition, the canal of Arantius, which is the ligamentum venosum in the embryonic phase, can be used as an anatomic reference to define the limit between segments 1 and 9.6, 7

Although

Results

We have performed the isolated resection of segment 1 with the hanging maneuver in 4 cases (Table 1). All of these procedures were completed successfully. Patients (3 men and 1 woman, aged 56–73 years) were diagnosed with metastases from colorectal cancer (3 cases) and breast cancer (1 case). No patient required blood transfusion during or after the operation. The mean tumor diameter was 3 cm (range 2–8 cm). The resection margin was negative in all patients (R0). There were no postoperative

Comments

The caudate lobe is commonly involved in metastatic or primary liver neoplasms. Several techniques to resect tumors in this lobe, including lobectomy, segmentectomy, caudate lobectomy, isolated caudate lobectomy, and partial hepatectomy, have been described in the literature.6, 7, 8, 12, 13, 14, 15, 16, 17 This highlights the lack of a standard technique and absence of uniform criteria to perform this type of surgery, which is likely because of the difficulty in performing this resection given

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