Different approaches to caudate lobectomy with "curettage and aspiration" technique using a special instrument PMOD: a report of 76 cases.
OBJECTIVE
To study different approaches to caudate lobectomy with "curettage and aspiration" technique using Peng's multifunctional operative dissector (PMOD). The surgical procedure of isolated complete caudate lobectomy was specially discussed.


METHODS
In 76 cases of various types of caudate lobectomy, three approaches were used including left side approach, right side approach, and anterior approach. Among the 76 cases, isolated complete caudate lobectomy was carried out in 6 cases with transhepatic anterior approach. The surgical procedure consisted of mobilization of the total liver, ligation and separation of the short hepatic veins, splitting the liver parenchyma through the Cantlie's plane, ligation and division of the caudate portal triads from the hilum, dissection of the root of major hepatic veins, detachment of the caudate lobe from liver parenchyma.


RESULTS
The mean operative time was 285+/-51 min, the mean blood loss was 1,600 ml. No severe complications were observed. Among the 6 cases receiving isolated complete caudate lobectomy with transhepatic anterior approach, one case died 17 months after operation due to disease recurrence and liver failure, the other 5 cases have been alive without recurrence, with one longest survival of 49 months.


CONCLUSIONS
The choice of approach is essential to the success of caudate lobectomy. As PMOD and "curettage and aspiration" technique can delineate intrahepatic or extrahepatic vessels clearly, caudate lobe resection has become safer, easier and faster.
Peng
Shu-You
SY
Department of Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No 88 Jie Fang Road, Hangzhou 310009, Zhejiang Province, China. sypeng@mail.hz.zj.cn
Li
Jiang-Tao
JT
Mou
Yi-Ping
YP
Liu
Ying-Bin
YB
Wu
Yu-Lian
YL
Fang
He-Qing
HQ
Cao
Li-Ping
LP
Chen
Li
L
Cai
Xiu-Jun
XJ
Peng
Cheng-Hong
CH
D000310:Adrenal Gland Neoplasms / Q000473:pathology; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology; D003475:Curettage / Q000295:instrumentation; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013396:Suction / Q000295:instrumentation