Background

Laparoscopic total caudate lobectomy remains a challenging procedure because of its deep location (Xu et al., Surg Endosc. 35:1138–47, 2021). Placement of intercostal ports can overcome the barriers of the ribcage for laparoscopic access (Hayashi et al., PLoS One.15:e0234919, 2020). We herein present a novel technique in which a left intercostal port was used as the main working port during laparoscopic caudate lobectomy.

Methods

An 84-year-old man with a 1-cm intrahepatic cholangiocarcinoma located in segment 1 (S1) was referred to our hospital. We planned laparoscopic isolated caudate lobectomy using a left intercostal port as the main working port. The patient was placed in the supine position. A 12-mm left intercostal port with a balloon was introduced in the seventh intercostal space as the main working port. After Arantius’ ligament was divided, the left Glissonean pedicle of S1 (G1) was divided using an endo-stapling device. The surgeon moved to the right side of the patient and divided the right G1, followed by transection to the inferior right hepatic vein. Again, the surgeon moved to the left side, and the left intercostal port was used for mobilization of the Spiegel lobe and parenchymal resection using a cavitron ultrasonic surgical aspirator, exposing the root of the left and middle main hepatic veins for completion of total caudate lobectomy.

Results

The operative time was 264 min and blood loss was 400 mL. The patient was discharged on a postoperative day 9 without complications.

Conclusions

A laparoscopic approach to the caudate lobe using a left intercostal port is a new and ideal technique providing effective manipulation.

中文翻译：

---

左肋间入路腹腔镜孤立全尾状叶切除术（附视频）

背景

由于位置较深，腹腔镜全尾状叶切除术仍然是一项具有挑战性的手术（Xu et al., Surg Endosc. 35:1138-47, 2021）。放置肋间端口可以克服腹腔镜进入胸腔的障碍（Hayashi 等人，PLoS One.15:e0234919, 2020）。我们在此提出了一种新技术，其中左肋间端口被用作腹腔镜尾状叶切除术的主要工作端口。

方法

一名 84 岁男性，肝内胆管癌 1 厘米，位于第 1 段（S1），被转诊到我院。我们计划使用左侧肋间端口作为主要工作端口的腹腔镜孤立尾状叶切除术。患者取仰卧位。在第 7 肋间引入一个 12 mm 的左肋间带球囊作为主要工作口。在 Arantius 的韧带被分割后，使用内吻合装置分割 S1 (G1) 的左侧 Glissonean 椎弓根。外科医生移动到患者的右侧并分开右侧 G1，然后横断至肝右下静脉。再次，外科医生移动到左侧，左侧肋间端口用于动员 Spiegel 肺叶并使用 cavitron 超声手术吸引器进行实质切除，

结果

手术时间264分钟，失血400毫升。患者在术后第 9 天出院，没有出现并发症。

结论

使用左侧肋间端口的尾状叶腹腔镜方法是一种新的和理想的技术，可提供有效的操作。