Skip to main content

Advertisement

SpringerLink
Log in

Isolated caudate lobectomy using a modified hanging maneuver

  • How-I-Do-It articles
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The caudate lobe is located deep in the dorsal portion of the liver. Complete resection is an extremely demanding surgery due to the limited surgical field, especially in cases with severe intra-abdominal complications. A major concern of isolated caudate lobectomy is the difficulty associated with securing the contralateral visual field during parenchymal transection. To overcome this issue, we present a new technique for isolated caudate lobectomy that uses a modified hanging maneuver.

Methods

We performed an anatomical isolated caudate lobectomy via the high dorsal resection technique using our new modified hanging maneuver in two patients with HCC in November and December 2019.

Results

Patient 1 was severely obese, so the upper abdominal cavity was occupied by a large amount of great omental fat, and fibrous adhesions were observed around the spleen. Patient 2 had undergone six preoperative treatments, and a high degree of adhesion was observed in the abdominal cavity around the liver. It was difficult to secure the surgical field due to severe abdominal complications in both cases. The total operation times in these two cases were 617 and 763 min, respectively, while the liver parenchymal dissection times of the caudate lobe were 96 and 108 min, respectively. The resection margin was negative in both patients (R0). Neither patient had any complications after surgery; both were discharged on postoperative day 14.

Conclusion

Our modified hanging maneuver is useful, particularly in cases with a narrow surgical field due to severe adhesions, bulky tumors, and/or hypertrophy of the Spiegel lobe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

HCC:

Hepatocellular carcinoma

IVC:

Inferior vena cava

CT:

Computed tomography

ICG:

Indocyanine green

MCT:

Microwave coagulation therapy

RFA:

Radiofrequency ablation

MHV:

Middle hepatic vein

LHV:

Left hepatic vein

RHV:

Right hepatic vein

IRHV:

Inferior right hepatic vein

CPHV:

Caudate process hepatic vein

RPV:

Right portal vein

References

  1. Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161(4):346–350

    CAS  PubMed  Google Scholar 

  2. Nakashima T, Kojiro M (1986) Pathologic characteristics of hepatocellular carcinoma. Semin Liver Dis 6(3):259–266. https://doi.org/10.1055/s-2008-1040608

    Article  CAS  PubMed  Google Scholar 

  3. Takayama T, Tanaka T, Higaki T, Katou K, Teshima Y, Makuuchi M (1994) High dorsal resection of the liver. J Am Coll Surg 179(1):72–75

    CAS  PubMed  Google Scholar 

  4. Takayama T, Midorikawa Y, Higaki T, Nakayama H, Moriguchi M, Aramaki O, Yamazaki S, Aoki M, Kogure K, Makuuchi M (2019) Algorithm for resecting hepatocellular carcinoma in the caudate lobe. Ann Surg. https://doi.org/10.1097/sla.0000000000003384

  5. Midorikawa Y, Takayama T (2012) Caudate lobectomy (segmentectomy 1) (with video). J Hepatobiliary Pancreat Sci 19(1):48–53. https://doi.org/10.1007/s00534-011-0450-1

    Article  PubMed  Google Scholar 

  6. Shindoh J, Imamura H, Kokudo N (2010) Isolated sling suspension during resection of the Spiegel lobe of the liver: a safe alternative technique for difficult cases. J Hepatobiliary Pancreat Sci 17(3):359–364. https://doi.org/10.1007/s00534-010-0274-4

    Article  PubMed  Google Scholar 

  7. Kitagawa S, Murakami G, Hata F, Hirata K (2000) Configuration of the right portion of the caudate lobe with special reference to identification of its right margin. Clin Anat 13(5):321–340. https://doi.org/10.1002/1098-2353(2000)13:5<321::Aid-ca2>3.0.Co;2-r

    Article  CAS  PubMed  Google Scholar 

  8. Kumon M (2017) Anatomical study of the caudate lobe with special reference to portal venous and biliary branches using corrosion liver casts and clinical application. Liver Cancer 6(2):161–170. https://doi.org/10.1159/000454682

    Article  PubMed  Google Scholar 

  9. Lerut J, Gruwez JA, Blumgart LH (1990) Resection of the caudate lobe of the liver. Surg Gynecol Obstet 171(2):160–162

    CAS  PubMed  Google Scholar 

  10. Yamamoto J, Takayama T, Kosuge T, Yoshida J, Shimada K, Yamasaki S, Hasegawa H (1992) An isolated caudate lobectomy by the transhepatic approach for hepatocellular carcinoma in cirrhotic liver. Surgery 111(6):699–702

    CAS  PubMed  Google Scholar 

  11. Colonna JO 2nd, Shaked A, Gelabert HA, Busuttil RW (1993) Resection of the caudate lobe through "bloody gultch". Surg Gynecol Obstet 176(4):401–402

    PubMed  Google Scholar 

  12. Yanaga K, Matsumata T, Hayashi H, Shimada M, Urata K, Sugimachi K (1994) Isolated hepatic caudate lobectomy. Surgery 115(6):757–761

    CAS  PubMed  Google Scholar 

  13. Kosuge T, Yamamoto J, Takayama T, Shimada K, Yamasaki S, Makuuchi M, Hasegawa H (1994) An isolated, complete resection of the caudate lobe, including the paracaval portion, for hepatocellular carcinoma. Arch Surg 129(3):280–284. https://doi.org/10.1001/archsurg.1994.01420270056013

    Article  CAS  PubMed  Google Scholar 

  14. Asahara T, Dohi K, Hino H, Nakahara H, Katayama K, Itamoto T, Ono E, Moriwaki K, Yuge O, Nakanishi T, Kitamoto M (1998) Isolated caudate lobectomy by anterior approach for hepatocellular carcinoma originating in the paracaval portion of the caudate lobe. J Hepato-Biliary-Pancreat Surg 5(4):416–421. https://doi.org/10.1007/s005340050066

    Article  CAS  Google Scholar 

  15. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R (2001) Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 193(1):109–111. https://doi.org/10.1016/s1072-7515(01)00909-7

    Article  CAS  PubMed  Google Scholar 

  16. Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Kim CM (2006) Isolated caudate lobectomy using the hanging maneuver. Surgery 139(6):847–850. https://doi.org/10.1016/j.surg.2006.01.004

    Article  PubMed  Google Scholar 

  17. Lopez-Andujar R, Montalva E, Bruna M, Jimenez-Fuertes M, Moya A, Pareja E, Mir J (2009) Step-by-step isolated resection of segment 1 of the liver using the hanging maneuver. Am J Surg 198(3):e42–e48. https://doi.org/10.1016/j.amjsurg.2009.02.012

    Article  PubMed  Google Scholar 

  18. Makuuchi M, Yamamoto J, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H (1991) Extrahepatic division of the right hepatic vein in hepatectomy. Hepatogastroenterology 38(2):176–179

    CAS  PubMed  Google Scholar 

  19. Kogure K, Kuwano H, Fujimaki N, Makuuchi M (2000) Relation among portal segmentation, proper hepatic vein, and external notch of the caudate lobe in the human liver. Ann Surg 231(2):223–228. https://doi.org/10.1097/00000658-200002000-00011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kogure K, Ishizaki M, Nemoto M, Kuwano H, Yorifuji H, Ishikawa H, Takata K, Makuuchi M (2007) Close relation between the inferior vena cava ligament and the caudate lobe in the human liver. J Hepato-Biliary-Pancreat Surg 14(3):297–301. https://doi.org/10.1007/s00534-006-1148-7

    Article  Google Scholar 

  21. Takayama T, Makuuchi M, Kubota K, Sano K, Harihara Y, Kawarasaki H (2000) Living-related transplantation of left liver plus caudate lobe. J Am Coll Surg 190(5):635–638. https://doi.org/10.1016/s1072-7515(00)00255-6

    Article  CAS  PubMed  Google Scholar 

  22. Yamazaki S, Takayama T, Makuuchi M (2010) The technical advance and impact of caudate lobe venous reconstruction in left liver: additional safety for living-related donor liver transplantation. Transpl Int 23(4):345–349. https://doi.org/10.1111/j.1432-2277.2009.01044.x

    Article  PubMed  Google Scholar 

  23. Hwang S, Lee SG, Ha TY, Ahn CS, Park KM, Kim KH, Lee YJ, Moon DB, Kim KK, Kim YD (2004) Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe. Liver Transpl 10(11):1398–1405. https://doi.org/10.1002/lt.20241

    Article  PubMed  Google Scholar 

  24. Ochiai T, Ishii H, Toma A, Ishimoto T, Yamamoto Y, Morimura R, Ikoma H, Otsuji E (2016) Modified high dorsal procedure for performing isolated anatomic total caudate lobectomy (with video). World J Surg Oncol 14:132. https://doi.org/10.1186/s12957-016-0896-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kogure K, Kuwano H, Yorifuji H, Ishikawa H, Takata K, Makuuchi M (2008) The caudate processus hepatic vein: a boundary hepatic vein between the caudate lobe and the right liver. Ann Surg 247(2):288–293. https://doi.org/10.1097/SLA.0b013e31815efd8d

    Article  PubMed  Google Scholar 

  26. Sakamoto Y, Kokudo N, Kawaguchi Y, Akita K (2017) Clinical anatomy of the liver: review of the 19th Meeting of the Japanese Research Society of Clinical Anatomy. Liver Cancer 6(2):146–160. https://doi.org/10.1159/000449490

    Article  PubMed  Google Scholar 

  27. Couinaud C (1989) Posterior or dorsal liver. In: Couinaud C (ed) Surgical anatomy of the liver revisited. Couinaud, Claude, Paris, pp 123–134

    Google Scholar 

  28. Couinaud C (1994) The paracaval segments of the liver. J Hepato-Biliary-Pancreat Surg 1(2):145–151. https://doi.org/10.1007/BF01222238

    Article  Google Scholar 

  29. Healey JE Jr, Schroy PC (1953) Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts. AMA Arch Surg 66(5):599–616. https://doi.org/10.1001/archsurg.1953.01260030616008

    Article  PubMed  Google Scholar 

  30. Cappelle M, Aghayan DL, van der Poel MJ, Besselink MG, Sergeant G, Edwin B, Parmentier I, De Meyere C, Vansteenkiste F, D'Hondt M (2020) A multicenter cohort analysis of laparoscopic hepatic caudate lobe resection. Langenbeck's Arch Surg 405(2):181–189. https://doi.org/10.1007/s00423-020-01867-2

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Azusa Okuwa of SAIKOU Inc. for the figure illustrations.

Author information

Authors and Affiliations

  1. Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan

    Taiji Tohyama, Yoshimi Fujimoto, Takayoshi Murakami, Kumi Sugiu, Yasutaka Kudou & Takamasa Matsumoto

Authors
  1. Taiji Tohyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshimi Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takayoshi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kumi Sugiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasutaka Kudou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takamasa Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Taiji Tohyama; acquisition of data: Taiji Tohyama, Yoshimi Fujimoto, Takayoshi Murakami, Kumi Sugiu, Yasutaka Kudou, Takamasa Matsumoto; analysis and interpretation of data: Taiji Tohyama; drafting of manuscript: Taiji Tohyama; critical revision: Taiji Tohyama.

Corresponding author

Correspondence to Taiji Tohyama.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tohyama, T., Fujimoto, Y., Murakami, T. et al. Isolated caudate lobectomy using a modified hanging maneuver. Langenbecks Arch Surg 406, 927–933 (2021). https://doi.org/10.1007/s00423-020-02048-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-020-02048-x

Keywords

Search

Navigation