Laparoscopic Hepatic Resection Research Articles

Clinicopathological correlation and post-resection outcomes of hepatic angiomyolipoma.

Backgrounds/AimsAngiomyolipoma is a rare neoplasm of mesenchymal origin derived from perivascular epithelioid cells. Due to rarity, hepatic angiomyolipoma (HAML) has been often misdiagnosed as hepatocellular carcinoma (HCC) or other hypervascular liver tumors based on imaging studies. This study investigated the clinicopathological correlation and post-resection outcomes of HAML.MethodsThis retrospective observational study included 40 patients who underwent hepatic resection (HR) for HAML between 2008 and 2018.ResultsMean age of the patients was 42.6±11.4 years and there were 30 (75.0%) females. Hepatitis B and C virus infection was present in 8 patients (20.0%) and 1 patient (2.5%), respectively. Preoperative diagnoses on imaging studies were HCC in 23 (57.5%) patients, HAML in 14 (35.0%) patients, focal nodular hyperplasia in 2 (5.0%) patients, and hepatic adenoma in 1 (2.5%) patient. Percutaneous liver biopsy was performed in 10 (25.0%) patients and HAML was diagnosed in all patients. Only 3 patients (7.5%) showed a slight elevation in the level of liver tumor markers. Major HR was performed in 10 (25.0%). Laparoscopic HR was performed in 9 (22.5%). The mean tumor size was 4.8±3.9 cm and single tumor was present in 38 (95.0%) patients. Currently, all the patients are alive without tumor recurrence during the follow-up observation period of 75.7±37.3 months.ConclusionsHAML is a rare form of primary liver tumor and is often misdiagnosed as HCC or other hypervascular tumors. Although HAML is benign in nature, it has malignant potential, thus resection is indicated if the tumor grows or malignancy cannot be excluded.

THERE ARE NO ADVANTAGES BETWEEN LAPAROSCOPIC AND OPEN LIVER RESECTIONS WITHIN AN ENHANCED RECOVERY PROGRAM (ERAS).

ABSTRACT Background: The use of a successful Enhanced Recovery After Surgery (ERAS) in colorectal surgery favored its application in other organs, and hepatic resections were not excluded from this tendency. Some authors suggest that the laparoscopic approach is a central element to obtain better results. Aim:To compare the laparoscopic vs. open hepatic resections within an ERAS to evaluate if there are any differences between them. Methods:In a descriptive study 80 hepatic resections that were divided into two groups, regarding to whether they were submitted to laparoscopy or open surgery. Demographic data, those referring to the hepatectomy and the ERAS was analyzed. Results: Forty-seven resections were carried out in open surgery and the rest laparoscopically; in the first group there was only one conversion to open surgery. Of the total, 17 resections were major hepatectomies and in 18 simultaneous resections. There were no differences between procedures regarding hospital stay and number of complications. There was a greater adherence to the ERAS (p=0.046) and a faster ambulation (p=0.001) in the open surgery. Conclusion: The procedure, whether open or laparoscopically done in hepatic resections, does not seem to show differences in an ERAS evaluation.

Laparoscopic resection of liver tumors in children

BackgroundLaparoscopy for the resection of liver tumors in children has remained undeveloped in comparison to adults. Most of the indications for pediatric laparoscopic hepatic surgery have been limited to diagnostic laparoscopy (biopsy). Over the past ten years, however, laparoscopic liver resections for pediatric hepatic diseases have been performed successfully, and many case reports have been published. MethodsThe authors report 6 cases of laparoscopic hepatic resection of benign tumors in children. The most important aspects of surgical technique are presented. There were 3 boys and 3 girls, with age between 4 months and 16 years. The lesions were located in the following segments: II and III (4 patients), I (1), V (1). The maximum tumor size was 7 cm. ResultsOne anatomical (left bisegmentectomy) and 5 nonanatomical resections were performed. Conversion to laparotomy was necessary in 1 patient owing to bleeding from the posterior branch of the right hepatic artery. There were no postoperative complications and patients were discharged on postoperative day 4, 5, 5, 5, 7 and 3 accordingly. The postoperative pathology of the specimens confirmed their benign nature: infantile hemangioendothelioma (1), nested stromal epithelial tumor (1), focal nodular hyperplasia (3), mixed benign tumor (hamartoma + vascular malformation) (1). ConclusionsThis report demonstrates the feasibility of a laparoscopic hepatic resection in children. On the other hand, laparoscopic liver resection is challenging and teamwork and specific training are necessary.

New device with force sensors for laparoscopic liver resection – investigation of grip force and histological damage

Introduction As the benefits of minimally invasive surgery are recognized, the rate of laparoscopic liver resection (LLR) is rapidly increasing. Liver tissue is fragile compared to tissue of the stomach and colon. In endoscopic and robotic surgery, sufficient tactile sensation is yet to be obtained. Therefore, it is necessary to measure and indicate the grip force of forceps during surgery. We developed a new device consisting of force sensors and investigated its grip force and the resulting histological damage to liver tissue. Material and methods We measured the grip force generated during laparoscopic surgery in pigs using the forceps with pressure sensors developed by us. Throughout the hepatectomy, we measured the grip force generated by the forceps in real time. We investigated the histological damage to the liver caused by using the forceps with different grip forces. Results The subject produced a mean grip force of 1.75 N during the procedures. The maximum grip force was 3.38 N. By grasping the tissues of the liver with forceps, bleeding and destruction of the hepatic lobules were observed in a manner dependent on increasing grip force. Conclusion The new device is necessary for preventing liver damage in laparoscopic hepatic resection.

Does laparoscopic liver resection provide better outcomes than thermoablation in patients with hepatocellular carcinoma?—A systematic review

Background: A systematic review has been accomplished to compare the outcomes of laparoscopic hepatic resection (LHR) with those of thermo-ablation (TA) therapies for hepatocellular carcinoma (HCC). Methods: A literature search has been accomplished to choose relevant studies published analyzing the EMBASE and PubMed databases and the Cochrane Library. Studies comparing the outcomes of LHR versus TA for HCC were included in the analysis. Results: The present meta-analysis included 9 studies for a total of 918 patients. It found that the complication rate in the TA group was significantly lower than that of the LHR group (OR: 0.52, 95% CI: 0.36–0.75, P=0.0005). Severe complications occurred in a range of 0–10% in the LHR group and in a range of 0–5% in the TA group. No postoperative mortality has been shown in both groups. The meta-analysis of the nine studies showed that the local recurrence rates were lower in LHR group than in TA group (OR: 6.43; 95% CI: 4.01–10.29; P Conclusions: Patients submitted to LHR had a better OS and a lower local recurrence rate than those submitted to TA. However, TA treatments have a low impact in the postoperative course of cirrhotic patients. In the future guidelines, LHR should have a primary role in first-line treatment for HCC, while in the situations that the condition of patients is not suitable to perform operation, TA might be the solution.

Retrospective Comparison between the Effects of Propofol and Inhalation Anesthetics on Postoperative Recurrence of Early- and Intermediate-Stage Hepatocellular Carcinoma

Objective: Previous studies have reported that propofol has antitumor, anti-inflammatory, and antioxidant effects in addition to its anesthetic properties. To confirm this, a retrospective investigation was conducted to determine whether different anesthetic agents, particularly propofol and inhalation anesthetics, have an effect on the recurrence of hepatocellular carcinoma (HCC) in patients who were diagnosed with primary HCC and underwent laparoscopic hepatectomy. Subjects and Methods: Patients with Barcelona Clinic Liver Cancer stages 0, A, and B HCC, who underwent laparoscopic hepatic resection, were enrolled in this study. Post­operative HCC recurrence, which was determined from postoperative liver CT, was evaluated 24 months postoperatively with respect to the main anesthetic agents. The characteristics of HCC and other patient-related or surgery-related variables were evaluated together. Results and Conclusion: During the 24-month period after hepatic resection, less HCC patients in the propofol group than in the inhalation group recurred (p = 0.046). The mean time to recurrence was 20.8 months (95% CI, 19.7–22.0) and 19.1 months (95% CI, 17.8–20.4) in the propofol group and the inhalation group, respectively. In addition, multivariable Cox proportional regression analysis revealed that the propofol group showed significantly decreased recurrence versus the inhalation group (hazard ratio, 0.57; 95% CI, 0.47–0.69; p = 0.029). When propofol was used as the main general anesthetic agent for laparoscopic hepatic resection, the postoperative 2-year recurrence rate decreased in early- and intermediate-stage HCC.

Surgical Resection of Hepatocellular Carcinoma in Compensated Cirrhotic Liver: The Benefits and Selection Criteria

Ab

Giving short-term prophylactic antibiotics in patients undergoing open and laparoscopic hepatic resection.

AimThe 2016 guidelines of the Japan Society for Surgical Infection and the Japan Society of Chemotherapy advocate giving prophylactic antibiotics 1 hour before surgery and until 24 hours after surgery in patients undergoing elective hepatic resection. However, the efficacy of short‐term antimicrobial prophylaxis has not been evaluated according to surgical approach. We evaluated the efficacy of giving prophylactic antibiotics in patients undergoing open or laparoscopic hepatic resection.MethodsThe study comprised 218 and 185 patients undergoing open and pure laparoscopic hepatic resection, respectively. Incidence rates of postoperative infectious complications were compared between patients who received flomoxef sodium as the prophylactic antibiotic before and until 24 hours after surgery (short‐term group) and those who received flomoxef sodium until 72 hours after surgery (long‐term group) among patients undergoing open or laparoscopic hepatic resection. Propensity score matching analysis was carried out to adjust for confounding factors between the short‐ and long‐term groups.ResultsThere was no significant difference in the postoperative infectious complication incidence between the short‐ and long‐term groups among patients undergoing open (18.9% vs 12.2%; P = 0.36) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection after propensity score matching. Incidence rate of surgical site infections was comparable between the short‐ and long‐term groups among patients undergoing open (13.5% vs 10.8%; P = 0.80) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection.ConclusionGiving short‐term prophylactic antibiotics might be sufficient in preventing postoperative infectious complications in patients undergoing open and laparoscopic hepatic resection.

Surgical site infection after laparoscopic hepatic resection

Surgical site infection after laparoscopic hepatic resection

Slow Gait Speed Is a Risk Factor for Complications After Hepatic Resection

PurposeThe aims of this study were to clarify the relationship of gait speed, hand grip strength, and skeletal muscle mass with complications after hepatic resection and to identify risk factors for complications in patients who underwent hepatic resection. MethodsWe evaluated the risk factors for complications after hepatic resection in 154 consecutive patients. Preoperative factors included gait speed, hand grip strength, and skeletal muscle mass. The gait speed and hand grip strength of patients were measured by physical therapists, and skeletal muscle mass was measured by computed tomography. Multivariate logistic regression analyses using preoperative factors were performed to assess predictors of the development of complications after hepatic resection. ResultsThirty-three patients (21.4%) developed complications after hepatic resection. These patients had a significantly lower serum albumin level (p = 0.015), slower gait speed (p = 0.007), higher rate of hepatic resection ≥ 2 Couinaud segments (p = 0.014), and lower rate of laparoscopic hepatic resection (p = 0.017) than patients without complications. Multivariate analysis revealed that a gait speed ≤ 1.10 m/s and a serum albumin level of ≤ 4.0 g/dl were independent risk factors for complications after hepatic resection. ConclusionsSlow gait speed and low serum albumin level are significant risk factors for complications after hepatic resection. These data will be helpful for perioperative patient management.

Laparoscopic Liver Resection with Augmented Reality: A Preclinical Experience.

Intraoperative imaging, such as ultrasound, provides subsurface anatomical information not seen by standard laparoscopy. Currently, information from the two modalities may only be integrated in the surgeon's mind, an often distracting and inefficient task. The desire to improve intraoperative efficiency has guided the development of a novel, augmented reality (AR) laparoscopic system that integrates, in real time, laparoscopic ultrasound (LUS) images with the laparoscopic video. This study shows the initial application of this system for laparoscopic hepatic wedge resection in a porcine model. The AR system consists of a standard laparoscopy setup, LUS scanner, electromagnetic tracking system, and a laptop computer for image fusion. Two liver lesions created in a 40-kg swine by radiofrequency ablation (RFA) were resected using the novel AR system and under standard laparoscopy. Anatomical details from the LUS were successfully fused with the laparoscopic video in real time and presented on a single screen for the surgeons. The RFA lesions created were 2.5 and 1 cm in diameter. The 2.5 cm lesion was resected under AR guidance, taking about 7 minutes until completion, while the 1 cm lesion required 3 minutes using standard laparoscopy and ultrasound. Resection margins of both lesions grossly showed noncoagulated liver parenchyma, indicating a negative-margin resection. The use of our AR system in laparoscopic hepatic wedge resection in a swine provided real-time integration of ultrasound image with standard laparoscopy. With more experience and testing, this system can be used for other laparoscopic procedures.

Laparoscopic hepatic surgery: Evolution in reference unit

Introduction: Despite the existing evidence in laparoscopic liver surgery, regarding safety, ease and similar results in survival, less than 15% of liver resections are performed through this route. Objective: To analyze the evolution of laparoscopic hepatic resections (LHR) in the last 14 years (2004-2017) in a unit of Hepatobiliopancreatic Surgery. Material and method: A descriptive study performed 152 RHL divided into three periods; 1st Period (1st P):2004-2009:41, 2nd Period (2nd P):2010-2014: 38 and 3rd Period (3rd P):2015-2017:73. Variables: demographic, etiology, size-number of the lesion, location , type of resection, surgical time, transfusion and / or conversion, use of drains, histology, morbidity and mortality and postoperative stay. Results: The average of RHL / year in 1ºP and 2ºP:6.8 and 7.6, while 3ºP:24.3 RHL / year. We observed a progressive increase in middle age (1ºP:54; 2ºP:60; 3ºP:62) and in malignant pathology (Metastasis, CHC and cholangiocarcinoma), 1ºP:34%, 2ºP: 60% 3ºP:67%. The highest RH were 2.6%:2ºP and 13.7%:3ºP. The surgical time has increased with the periods (1ºP:173min, 2ºP:203min, 3ºP:246min). The need for transfusion(14%) and the use of drainages(30%) have been similar between periods. The conversion to open surgery decreased from 1ºP(20%) to 3ºP(15%). The complications were greater in 3ºP(26%). However, Clavien≥III decreased in 2ºP and 3ºP(7.3%, 2.6%, 5.4%). There was no mortality. The average stay was similar (1º-2º:3 days vs 3ºP:4 days) Discussion: We found a significant increase in the number of RHL in our unit, expanding indications and types of resections, mainly major resections, without this having produced an increase in serious complications.

Multimodal radiofrequency ablation versus laparoscopic hepatic resection for the treatment of primary hepatocellular carcinoma within Milan criteria in severely cirrhotic patients: long-term favorable outcomes over 10years.

Less invasiveness is an important consideration for the treatment of hepatocellular carcinoma (HCC) especially in patients with severe cirrhosis. Between April 2000 and September 2016, 100 patients with liver damage B underwent multimodal radiofrequency ablation (RFA; n = 62) or laparoscopic hepatic resection (Lap-HR; n = 38) for primary HCC as defined by the Milan criteria. We compared the operative outcomes and patients' survival between the two groups. The RFA group showed worse liver functions as indicated by indocyanine green retention rate (32.9 vs. 22.4%; p < 0.0001) and serum albumin value (3.3 vs. 3.6g/dl; p = 0.0029). As expected, RFA was less invasive, as indicated by the differences in operation time (166 vs. 288min.; p < 0.0001) and blood loss (8 vs. 377g; p < 0.0001). There was no significant difference in the morbidity rate between the two groups; however, the duration of hospital stay of the RFA group was significantly shorter (7 vs. 11 days; p = 0.0002). There were no significant between-group differences regarding overall or disease-free survival. Multimodal RFA for HCC in patients with severe cirrhosis is associated with less invasiveness and shorter hospital stays, with no compromise in the patients' survival. In patients with severe cirrhosis, it may be time to consider changing the standard treatment for primary HCC within the Milan criteria to multimodal RFA.

Comparison of resection site of standardized laparoscopic hepatic tumor resection.

IntroductionThe degree of difficulty in laparoscopic hepatic resection (LHR) was higher in tumors involving the suprahepatic segments than other sites. However, thanks to surgical instruments and procedures being improved and standardized, LHR can be performed safely in all regions.AimWe report our standardized surgical techniques and outcomes in a series of patients undergoing LHR in our hospital and analyze the surgical outcomes, particularly with regard to the site of resection.Material and methodsWe retrospectively analyzed data from 238 patients who underwent standardized laparoscopic partial hepatic resection between 2010 and 2017. In standardized LHR, the operator formed a triangle with the laparoscope in the center, maintaining a co-axial position by changing the port where the laparoscope was inserted.ResultsOperative time for the resection of tumors of the right hepatic lobe was 202 ±92 min and 140 ±104 min for tumors of the left hepatic lobe (p = 0.0024); intraoperative blood loss was 80 ±170 ml and 19 ±127 ml, respectively (p = 0.0016). No differences were found in the surgical outcomes between the various segments of the right hepatic lobe. In the left hepatic lobe, operative time was significantly shorter with laparoscopic tumor resection in segment III (p = 0.0023).ConclusionsDuring standardized LHR, a better field of vision with the greater ease can be established during resection of the left hepatic lobe compared to that of the right hepatic lobe. Nonetheless, LHR of the right lobe can be performed safely using various surgical instruments and techniques.

Clinical analysis of laparoscopic right hepatic posterior lobectomy for hepatoma(with 76 cases report)

Objective To explore the clinical value of laparoscopic right hepatic posterior lobectomy for the safety and efficacy of the treatment of right hepatic posterior lobe tumor. Methods We collected patients′ clinical data for summary review, those who underwent laparoscopic right posterior lobectomy in our hepatobiliary department from Nov. 2013 to Feb. 2017. Then, we evaluated the safety and efficacy of laparoscopic right posterior lobectomy for the treatment of right posterior lobe tumor. Results In this study, 76 patients were included and 70 patients underwent laparoscopic subtotal lobe resection. The hepatic blood flow was blocked by Pringle method with an incidence of 72.37% (55/76). The mean operative time was(266.04 ± 87.44)min.The intraoperative blood transfusion rate was 10.53% (8/76) and intraoperative blood loss was(330.21 ± 163.51)ml.There were 6 cases undergoing open surgery. Thus, the transfer rate was 7.89% (6/76). As for postoperative complications, the postoperative bile leakage rate was 2.63% (2/76). There was no perioperative death and re-operation case occurred within 30 days. After the operation, the average time for hospital stay were (7.14 ± 3.39)days. All patients were followed up and the follow-up time lasted from 6 to 36 moths. Patients checked for their condition every 3 to 6 months after leaving the hospital. Malignant tumor-free survival time was (18.38 ± 6.80) months, and there was no patient dead during the follow-up period. Conclusions In the center of rich experience of laparoscopic hepatectomy , strict indications, rational use of surgical techniques, equipment, complete laparoscopic right hepatic lobe resection for the treatment of right posterior lobectomy tumors is safe and effective, worthy of further promotion. Key words: Laparoscopy; Right hepatic posterior lobectomy; Hepatoma

Total laparoscopic management of lesions involving liver superior-posterior segments

Proven advantages of laparoscopic surgery and advances in medicine technology triggered the increase of laparoscopic hepatic resection therapy. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. In this video, we aimed to show the laparoscopic resection of liver metastasis located at s7 in a challenging, morbidly obese patient.

Surgical outcome of laparoscopic hepatic resection for hepatocellular carcinoma: A matched case-control study with propensity score matching.

Background:Although the number of reports on laparoscopic hepatic resection (LHR) has increased, studies of long-term outcomes regarding tumor recurrence and patient survival compared to the conventional open approach are limited. We evaluated the long-term survival and feasibility of LHR in patients with hepatocellular carcinoma (HCC).Patients and Methods:A retrospective analysis was performed on the clinical data of patients who underwent hepatic resection for primary HCC between August 2000 and December 2013. The patients were divided into the LHR or open hepatic resection (OHR) groups. To control for selection bias in the two groups, propensity score matching was used at a 1:1 ratio based on the following covariates: Child–Pugh grade, tumour size, tumour number and tumour location. Following propensity score matching, thirty patients were included in the LHR group and thirty were included in the OHR group.Results:The respective disease-free survival rates at 1 year, 3 years and 5 years were 78.4%, 61.1% and 38.9%, respectively, for the LHR group, and 89.3%, 57.5% and 47.9%, respectively, for the OHR group (P = 0.89). Also, the overall survival rates at 1 year, 3 years and 5 years were 96.4%, 68.2% and 62.5%, respectively, for the LHR group and 100.0%, 95.8% and 72.3%, respectively, for the OHR group (P = 0.44).Conclusions:According to our study, using propensity score matching, LHR for HCC is safe, feasible and comparative, with good oncologic results.

Surgical Resection vs. Ablative Therapies Through a Laparoscopic Approach for Hepatocellular Carcinoma: a Comparative Study

BackgroundWhen compatible with the liver functional reserve, laparoscopic hepatic resection remains the treatment of choice for hepatocellular carcinoma while laparoscopic ablation therapies appear as a promising less invasive alternative. The aim of the study is to compare two homogeneous groups of patients submitted to either hepatic resection or thermoablation for the treatment of single hepatocellular carcinoma (≤ 3 cm). MethodsWe enrolled 264 cirrhotic patients out of 905 cases consecutively evaluated for hepatocellular carcinoma. We performed 59 hepatic resections and 205 thermoablations through a laparoscopic approach, and they were then followed for similar follow-up (41.7±31.5 months for laparoscopic hepatic resection vs. 38.7±32.3 for laparoscopic ablation therapy). Outcomes included short- and long-term morbidities, tumoral recurrence, and overall survival. ResultsShort-term morbidity was significantly higher in the resection group (but the two groups had similar rates for severe complications) while, during follow-up, recurrence was more frequent in patients treated with thermoablation, with a clear disadvantage in terms of survival. At multivariate analysis, only the type of surgical treatment was an independent predictor of disease recurrence, while plasmatic alpha-fetoprotein and Hb values, model for end-stage liver disease score, time to recurrence, and the type of surgical treatment were independent predictors of overall survival. ConclusionOur data ultimately support some therapeutic advantages for hepatic resection in patients with a single nodule and preserved liver function. However, thermoablation is an adequate alternative in patients with nodules that would require complex surgical resections or imply a poor prognosis that might therefore better tolerate a less invasive procedure.

Laparoscopic Hepatic Resection Using Extracorporeal Pringle Maneuver.

Laparoscopic hepatic resection (LHR) has been developed as a novel minimally invasive surgery. However, despite improvements in equipment and procedures, intraoperative hemorrhage remains an issue that requires great precaution. To reduce the amount of intraoperative blood loss, we perform the Pringle maneuver, aimed at occluding the inflow of blood into the liver during LHR. This article describes our experience performing LHR using the Pringle maneuver, including postoperative results, and discusses the safety and effectiveness of the Pringle maneuver. Data from 83 patients who underwent laparoscopic partial right hepatic resection with or without the Pringle maneuver were retrospectively analyzed with respect to surgical outcomes, safety, and utility. In LHR, the amount of bleeding was significantly lower in cases that included the Pringle maneuver (P = .0314). However, there were no differences in the duration of surgery, surgical margin, rate of curative resections, and incidence of postoperative complications. Laboratory data collected after surgery showed no significant difference between the two groups regardless of whether blood flow was occluded or not. The Pringle maneuver may be effective in reducing the amount of intraoperative blood loss during laparoscopic partial right hepatic resection, although the difference is not clinically significant. Rather, the reduction in bleeding can reduce the stress experienced by the operator while keeping the transection stump of the liver dry. Particularly, the extracorporeal Pringle maneuver using cotton tape is simple and convenient and can be carried out within a short amount of time.

Laparoscopic hepatic caudate lobe resection: a report of 7 patients

Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resection. Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed. There were 3 male and 4 female patients. The mean age was 45.3 years. The primary diseases included hepatic haemangioma (n=2) , metastatic liver cancer (n=2), hepatocellular carcinoma (n=1), recurrent hepatocellular carcinoma (n=1) and hepatic adenoma (n=1). The total blood loss, operation time, hospital stay after surgery and complication were analyzed. Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery. Five patients underwent partial caudate lobe resection, and the remaining 2 underwent combined left hemihepatectomy with partial caudate lobe resection. The operation time ranged from 200 to 250 minutes with a mean of 235 minutes. The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml. There was no postoperative bleeding and bile leakage. The resections were all R0 resections. Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients. Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery. Key words: Liver neoplasms; Liver caudate lobe; Hepatectomy; Laparoscope