Standardization of surgical procedures for laparoscopic Spiegel lobectomy: A single-institutional experience

INTRODUCTION

Surgical techniques for Spiegel lobectomy remain technically difficult because of its deep anatomical location. Laparoscopic Spiegel lobectomy has not yet been standardized or widely reported. In the current study, we introduce technical improvements, including the liver hanging maneuver, to laparoscopic Spiegel lobectomy. Additionally, we demonstrate the safety and feasibility of this procedure.

MATERIALS AND SURGICAL TECHNIQUE

We performed consecutive laparoscopic Spiegel lobectomy on six patients: five with hepatocellular carcinoma and one with colorectal liver metastasis. As preparation before liver parenchymal resection, necessary and sufficient mobilization of the Spiegel lobe was performed. A few Glissonian pedicles of the Spiegel lobe were exposed from the hilar plate and divided to reduce the inflow to the Spiegel lobe. After that, vessel tape was used in the hanging maneuver. The tape was pulled forward to give the cutting plane moderate tension during liver parenchymal resection. Lifting this tape provided better exposure for determining the correct cutting plane during liver parenchymal transection. The median operation time was 207 min (range, 147-240 min) and the median intraoperative blood loss was 35 mL (range, 15-85 mL). There were no severe postoperative complications.

DISCUSSION

We safely performed laparoscopic Spiegel lobectomy. To maintain a sufficient surgical view, especially during liver parenchymal resection, the hanging maneuver may be a useful technique. This single-center investigation into standardized laparoscopic Spiegel lobectomy featuring improvements in technique showed potential for favorable results.

Surgical treatment for the excluded bile leakage from Spiegel lobe after right hemihepatectomy: A case report

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There is anomaly that bile ducts and portal veins of the Spiegel lobe do not run together.

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Incidence of bile leakage after hepatic surgery was reported to be 2.6–15.6%.

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A number of treatment strategies for excluded bile leakage have been reported.

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Surgical treatment for excluded bile leakage is a quick and reliable procedure.

Inroduction

The treatments of excluded bile duct leakage after hepatectomy are not easy and various strategies have been reported, such as surgery, ethanol or fibrin glue injection, and portal vein embolization.

Presentation of case

A 72-year-old man with a surgical history of laparoscopic ileocecal resection for diverticular bleeding was diagnosed as having hepatocellular carcinoma. Right hemihepatectomy was performed, and computed tomography examination on postoperative day 9 showed abdominal fluid collection in the right subphrenic space. Percutaneous intra-abdominal fluid drainage was performed and it was diagnosed as bile leakage. After that it was diagnosed as excluded bile leakage from the Spiegel lobe by drip infusion cholangiographic-computed tomography and endoscopic retrograde cholangiography. To improve this clinical condition, we performed the Spiegel lobe excision on postoperative day 48. The postoperative course was uneventful and the patient was discharged.

Discussion

According to the postoperative examination, it appeared that the bile duct from the Spiegel lobe joined to the right main bile duct or the bile duct of the right posterior section. This bile duct anomaly was not detected preoperatively on imaging examination. It is most likely that the bile duct from the Spiegel lobe was cut when the hepatoduodenal ligament in the hepatic hilum was peeled. To prevent excluded bile leakage, the hepatoduodenal ligament should be carefully peeled and ligated instead of using energy devices.

Conclusion

We consider that surgical treatment for postoperative excluded bile leakage is both a quick and reliable procedure in patients with acceptable liver function and anatomical subject.

Isolated caudate lobectomy: Left-sided approach. Case reports

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The options of treatment for caudate tumors are presented.

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Treatment of caudate tumors by left-sided approach is proposal.

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Better results with left-sided approach are discussed.

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Selection of patients with tumors in caudate lobe for left-sided approach is important.

Introduction

The caudate lobe is a distinct liver lobe and surgical resection requires expertise and precise anatomic knowledge. Left-sided approach was described for resection of small tumors originated in the Spiegel lobe but now the procedure has been performed even for tumors more than five centimeters. The aim of this study is to present three cases of tumor of caudate lobe underwent isolated lobectomy by left-sided approach.

Presentation of case

Three patients with metastasis of colorectal cancer, carcinoma hepatocellular and metastasis of neuroendocrine tumor underwent resection. After modified Makuuchi incision, early control of short hepatic e short portal veins before hepatectomy was performed. The operative time was 200, 270 and 230 min respectively. No blood transfusion was used and no postoperative complications were observed. The length of stay was 7, 11 and 5 days respectively.

Discussion

Some approaches have been described to access and resect tumors of the caudate lobe, including the left-sided approach, right-sided approach, combined left- and right-sided approach and the anterior transhepatic approach. For liver resection in patients with malignant disease, parenchymal preservation is important in order to avoid postoperative liver failure or due to the risk of second hepatectomy. In these patients isolated caudate lobectomy is a safe option.

Conclusion

Isolated caudate lobectomy is a feasible procedure. Left-sided approach can be preformed even for tumors larger than 5 cm.

Hepatic abscess in the Spiegel lobe caused by foreign body penetration: report of a case report. Surg Case Rep. 2017;3:24. [PMID: 28188512 PMCID: PMC5307392 DOI: 10.1186/s40792-017-0297-z]

A 69-year-old male patient visited our hospital because of a continuous low-grade fever and right back pain since 2 weeks. Enhanced computed tomography (CT) of his abdomen revealed a mass with ring enhancement (35 × 30 mm) in the Spiegel lobe as well as a needle-like foreign body. Because conservative treatment by fasting and administration of antibiotics was unsuccessful, the patient underwent emergency laparotomy for removal of the foreign body and drainage of the liver abscess. The patient made a satisfactory postoperative recovery without complications and was discharged on the eighth postoperative day. The foreign body was composed of both protein and calcium phosphate and was histologically diagnosed as matured bone. We herein report successful surgical treatment of a patient with a liver abscess in the Spiegel lobe caused by foreign body penetration.