Gon Hidetoshi, Kido Masahiro, Komatsu Shohei, Fukushima Kenji, Urade Takeshi, Nanno Yoshihide, Tsugawa Daisuke, Yanagimoto Hiroaki, Toyama Hirochika, Fukumoto Takumi
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
Ann Surg Oncol. 2023 Jan;30(1):381-382. doi: 10.1245/s10434-022-12667-x. Epub 2022 Oct 25.
Laparoscopic caudate lobe resection is a challenging procedure. Several researchers have reported the safety of laparoscopic liver resections;1.Transl Gastroenterol Hepatol. 1:56;2.Asian J Endosc Surg. 12:232-236;3.Ann Surg Oncol. 26:2980; however, a standardized procedure has not yet been established. Herein, we present a video showing laparoscopic Spiegel lobectomy in a patient with 6-cm hepatocellular carcinoma (HCC) using a novel approach.
A 63-year-old man with a caudate lobe HCC was referred to our hospital. Computed tomography showed a 5 × 6 cm HCC located in the Spiegel lobe, which profoundly displaced the inferior vena cava (IVC) to the lower right side, and mobilization of the Spiegel lobe was considered difficult. To perform the dissection between the Siegel lobe and IVC safely, we performed parenchymal transection along the ventral side of the IVC initially. The Spiegel lobe was then dislocated to the left side of the IVC. We dissected the left lateral side of the IVC, including the proper hepatic vein draining the caudate lobe and the left IVC ligament with a safe operative field, and successfully removed the Spiegel lobe with large HCC.
The operation time was 383 min. The blood loss was 10 mL. The patient was discharged on the seventh postoperative day without any complications. Histopathological examination revealed well-differentiated HCC with a negative surgical margin.
Laparoscopic medial-to-lateral approach with initial parenchymal transection at the medial side of the Spiegel lobe followed by dissection of the left lateral side of the IVC is considered as a safe and effective procedure for large tumors in the Spiegel lobe.
腹腔镜尾状叶切除术是一项具有挑战性的手术。一些研究人员报告了腹腔镜肝切除术的安全性；1.《转化胃肠病学与肝病学》。第1卷：第56页；2.《亚洲内镜外科学杂志》。第12卷：第232 - 236页；3.《外科肿瘤学年鉴》。第26卷：第2980页；然而，尚未建立标准化的手术流程。在此，我们展示一段视频，该视频展示了采用一种新方法对一名患有6厘米肝细胞癌（HCC）的患者进行腹腔镜斯皮格尔叶切除术。
一名患有尾状叶HCC的63岁男性被转诊至我院。计算机断层扫描显示一个5×6厘米的HCC位于斯皮格尔叶，该肿瘤将下腔静脉（IVC）显著向右下方推移，并且认为斯皮格尔叶的游离较为困难。为了安全地在斯皮格尔叶与IVC之间进行分离，我们最初沿着IVC腹侧进行实质切开。然后将斯皮格尔叶脱位至IVC左侧。我们在安全的手术视野下分离IVC左侧，包括引流尾状叶的肝固有静脉和左IVC韧带，并成功切除了带有大HCC的斯皮格尔叶。
手术时间为383分钟。出血量为10毫升。患者术后第七天出院，无任何并发症。组织病理学检查显示为高分化HCC，手术切缘阴性。
对于斯皮格尔叶的大肿瘤，腹腔镜由内侧向外侧的入路，先在斯皮格尔叶内侧进行实质切开，然后分离IVC左侧，被认为是一种安全有效的手术方法。
