Isolated caudate lobectomy using a modified hanging maneuver.

Area of Science:

• Hepatobiliary Surgery
• Surgical Techniques
• Minimally Invasive Procedures

Background:

• The caudate lobe's deep dorsal liver location presents surgical challenges.
• Limited surgical fields and intra-abdominal complications complicate complete resection.
• Securing a contralateral visual field during parenchymal transection is difficult in isolated caudate lobectomy.

Purpose of the Study:

• To introduce a novel modified hanging maneuver for isolated caudate lobectomy.
• To address the challenges of limited surgical fields in caudate lobe resection.
• To evaluate the efficacy of the modified hanging maneuver in complex cases.

Main Methods:

• Anatomical isolated caudate lobectomy using a high dorsal resection technique.
• Implementation of a novel modified hanging maneuver.
• Procedure performed on two patients with hepatocellular carcinoma (HCC) in November and December 2019.

Main Results:

• The modified hanging maneuver was applied in two patients with severe abdominal complications (obesity, extensive adhesions).
• Total operation times were 617 and 763 minutes; caudate lobe dissection times were 96 and 108 minutes.
• Both patients achieved negative resection margins (R0), experienced no postoperative complications, and were discharged on postoperative day 14.

Conclusions:

• The modified hanging maneuver is effective for isolated caudate lobectomy.
• It is particularly beneficial in cases with narrow surgical fields, severe adhesions, bulky tumors, or hypertrophy of the Spiegel lobe.
• This technique enhances surgical feasibility and patient outcomes in complex liver resections.