Laparoscopic Resection of the Caudate Lobe

Abstract

The caudate lobe (CL) of the liver is located between the porta hepatis (PH) and the inferior vena cava (IVC). It is divided into three parts: the Spiegel process (SP) (Couinaud’s Segment 1), the paracaval portion (Couinaud’s Segment 9), and the caudate process (CP). The Spiegel lobe is situated behind the ligamentum venosum (LV) and lies on the left of the IVC. The paracaval portion is located in front of the IVC. The caudate process extends to the left and can be used for the traction of the caudate lobe. The caudate lobe is supplied by branches of hepatic artery and portal vein (CPV), and the bile is drained by branches of hepatic duct (HD); these vessels and ducts are called caudate portal triad (CPT). The blood of the caudate lobe usually drains directly into the IVC through the short hepatic veins (SHVs) and, in some cases, drains through the hepatic veins (Fig. 6.1). The CPT and the SHVs are important structures in the resection of the caudate, and in most cases, they can be divided before the transection of the liver parenchyma. It is difficult to define the transection line in the completely isolated caudate lobectomy. Takayama et al. (1991) suggested a counterstaining identification technique to define the surgical margin in 1991, but it was not routinely used in the resection of the caudate lobe. Normally, we performed the resection of the caudate lobe along the line from the caudate process to the tip of the caudate lobe.