Laparoscopic Caudate Lobectomy with Vena Cava Repair

Abstract

Laparoscopic resection of the caudate lobe is technically demanding procedure in liver surgery. The surgical strategy and technique are influenced by various aspects, and the caudate lobe blood supply, bile duct origins and venous drainage should be carefully evaluated in preoperative imaging. We report a case of isolated laparoscopic complete caudate lobectomy for a benign symptomatic tumour and the laparoscopic management of vena cava injury. The tumour, measuring 6 cm, compressed the vena cava and dislocated the origins of the middle and left hepatic veins anteriorly. A CT scan showed central scarring, a sign of focal nodular hyperplasia (FNH), and percutaneous biopsy confirmed the diagnosis. The operation was performed in a Davis-Lloyd position; 5 ports were placed in the semilunar line above the umbilicus. The procedure included cholecystectomy and dissection of the left Glissonian pedicle. The surgical procedure was complicated by vena cava perforation. During the final step, 15 mm of the vena cava wall was injured. Vena cava bleeding was initially controlled with a laparoscopic clamp, following which the vena cava wall was sutured with continuous 3/0 stiches (PDS, Ethicon). The tumour was placed in a bag and removed from the abdominal cavity through a Pfannenstiel incision. The operative time was 190 min, and hemiliver clamping lasted for 20 min. The estimated blood loss was 300 ml, and no blood transfusion was required. The patient recovered well and was discharged on postoperative day 6; no postoperative complications occurred. The patient was doing well 3 months after surgery, and all symptoms reported preoperatively had disappeared.