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On February 14, 2026, the team led by Professors Sun Baicheng and Xu Qingxiang from the First Affiliated Hospital of Anhui Medical University published a review titled "Laparoscopic Resection of Caudate Lobe Liver Tumors in Clinical Practice" in iNew Medicine. This paper, integrating mature clinical practice experience and cutting-edge research advancements, systematically expounded the anatomical basis, surgical planning principles, key operation points, indication selection, and future development directions of laparoscopic resection of liver caudate lobe tumors. It comprehensively summarized the entire clinical implementation process of this highly challenging minimally invasive surgery.
The article first clarifies the anatomical characteristics of the caudate lobe of the liver and the advantages and disadvantages of laparoscopic surgery. The caudate lobe can be anatomically divided into three parts: Spiegel leaf, caudal spur, and the part adjacent to the vena cava. Each part has a relatively independent vascular and biliary system. The existence of the Laennec capsule provides a clear anatomical plane for the safe separation of the parenchyma of the caudate lobe and the liver vein wall during laparoscopic surgery. The advantages of laparoscopic technology are fully exerted in this area: the magnified field of view enables precise identification of small vascular and biliary branches, multiple-angle lenses can break through the blind spots of open surgery, and combined with intraoperative low central venous pressure anesthesia, it can more safely complete the dissection and anatomy of the vena cava side. However, the article also points out that this surgical method has inherent limitations. For obese patients and those with severely deformed livers, the intraoperative exposure is extremely difficult. The control of bleeding in a narrow space and the technical threshold of laparoscopic suturing operation are extremely high. Moreover, the one-way nature of the instrument operation will also form a blind area in the field of vision during the removal of large tumors, increasing the risk of vascular injury.
In terms of surgical planning, the article emphasizes that the pathological nature, size, and anatomical location of the tumor should be the core considerations, balancing the two core goals of radical tumor resection and functional liver parenchyma protection. For benign tumors such as hepatic hemangioma and focal nodular hyperplasia, the surgery focuses on complete removal of the lesion and maximum preservation of normal liver tissue; for malignant tumors such as hepatocellular carcinoma, the primary goal is to achieve a negative surgical margin R0 radical resection. In cases where the anatomical structure is restricted, at least a microscopic negative margin at the junction with major blood vessels must be ensured. The article specifically points out that tumors larger than 4 cm will significantly increase the surgical difficulty. For large-volume malignant tumors that significantly push against surrounding tissues, combined adjacent liver segment or hemi-liver resection is the preferred strategy to reduce surgical complexity, ensure surgical safety, and achieve tumor radicality.
Regarding the most commonly used surgical methods, the article also breaks down the core operation points one by one. For Spiegel leaf tumors with relatively independent anatomy, the surgery follows a standardized three-step process: first, the gap between the Spiegel leaf and the inferior vena cava is isolated, the venous ligament is severed, and the short hepatic vein that drains into the left side of the inferior vena cava is precisely ligated to control the bleeding risk at the source; then, the Glisson pedicle of the Spiegel leaf is separated and severed, and the Pringle maneuver can be used to block the hepatic blood flow to assist the operation; finally, the liver parenchyma is dissected from the tail side to the head side along the established plane, avoiding iatrogenic injury to the middle hepatic vein and left hepatic vein throughout the process. For tumors in the caudate process area, the fluorescence navigation technology with indocyanine green (ICG) injection 24-48 hours before the operation is the key to achieving precise tumor localization and margin planning. The surgery needs to first fully free the posterior right liver space, properly handle the short hepatic vein and right hepatic vein beside the inferior vena cava, and then complete the precise resection of the lesion under fluorescence guidance. For total caudate lobe resection, the 30-degree laparoscopic bilateral alternate approach is the technical core, and for complex cases, the strategy of combined left lateral lobe and right posterior lobe resection can effectively improve intraoperative exposure and significantly reduce the operation difficulty.
The article finally summarizes the four core principles that laparoscopic caudate lobe tumor resection must follow: first, preoperative surgical planning must be completed through 3D imaging for fine planning; second, short hepatic veins and hepatic portal vascular structures must be systematically controlled during the operation to prevent fatal bleeding at the source; third, a stepwise precise dissection technique must be adopted to ensure the safe dissection of vascular roots; fourth, for complex cases, a combined liver lobe resection strategy must be adopted to simplify the surgical process. At the same time, the article also clarifies the indications and contraindications of this surgical method. The ideal surgical candidate is usually a benign tumor with a diameter not exceeding 15 cm, a malignant tumor with a diameter not exceeding 10 cm, and the lesion is localized without distant metastasis, with a separable anatomical plane between the inferior vena cava and the main hepatic vein, and good liver function reserve. For cases where the tumor invades or surrounds major blood vessels, infiltrates the hepatic portal area, or has severe liver cirrhosis and portal hypertension, open surgery should be preferred.
In terms of future development, the article states that with the popularization of neoadjuvant therapy, some previously unresectable lesions can obtain the opportunity for laparoscopic surgery after tumor downstaging. The robotic surgical platform, with its precise operation advantages in narrow spaces, will also inject new vitality into the development of this surgical method. However, regardless of how the technology evolves, surgical safety and tumor radicality remain the unshakable core principles of laparoscopic caudate lobe tumor resection.
Please provide the original link so that I can translate it accurately and fluently, https://onlinelibrary.wiley.com/doi/10.1002/inm3.70024
