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Laparoscopic Caudal Approach of the Inferior Vena Cava for Isolated Segment 1 Liver Resection
Jaume Tur-Martínez1, Èric Herrero-Fonollosa2, María Isabel García-Domingo2
1Hepatobiliary and Pancreatic Surgery Unit, Hospital Universitari Mútua Terrassa, Plaça Dr. Robert, 5, 08221, Terrassa (Barcelona), Spain. jaume.tur.martinez@gmail.com.
Introduction:
Isolated laparoscopic resection of the hepatic caudate lobe (segment 1) is a very challenging procedure. Very few references are available on this technique, and the aim of this paper is to show the main technical aspects of laparoscopic caudal approach for segment 1.
Material And Methods:
The subject was a 64-year-old woman with a past medical history of surgically treated breast cancer (pT1N0M0, with positive hormonal receptors). Adjuvant treatment was administered as well as radiotherapy and hormone therapy (tamoxifen). After 12 months of follow-up, an 18-mm single liver metastasis was detected in segment 1, suggestive of metastatic disease. A complementary study was conducted with magnetic resonance imaging, computed tomography and positron emission tomography, and no other lesions were identified.
Results:
Isolated laparoscopic resection of segment 1 of the liver was performed with a caudal approach of the inferior vena cava. All the steps are extensively described. The surgery time was 120 min, and blood loss was less than 100 ml. No postoperative complications were registered. The patient was discharged on the third postoperative day.
Conclusion:
Isolated laparoscopic resection of the hepatic caudate lobe with a caudal approach of the inferior vena cava is a safe technique in selected patients and should be performed in centres with experience in liver surgery and advanced laparoscopy, because of its high complexity.
