ASO Author Reflections: Laparoscopic Caudate Resection in Advanced Cirrhosis: Are We Transferring the Pain from the Patient to the Surgeon?

Abstract

The caudate lobe of the liver has a uniquely complex anatomy. It is located behind both the right and left lobes and is surrounded by hepatic veins, the hepatic hilum, and the inferior vena cava (IVC) (Fig. 1). 1 It is this hidden location and complex inflow and outflow that makes its removal difficult for laparoscopic and open surgery. In cirrhotic patients, the complexity of a caudate resection is magnified as the resulting compensatory left lobe and caudate hypertrophy can make access to the IVC challenging and the stiff fibrotic liver complicates rotation for exposure. In this context, compared with open surgery, the laparoscopic 'caudate view' aligns the viewing axis of the surgeon with the axis of the IVC, helping to overcome these exposure challenges. 2 Moreover, laparoscopic liver surgery (LLS) may have specific advantages for patients with liver cirrhosis. 3,4 The reduced access trauma of the small incisions results in less disruption of collaterals through the abdominal wall and less need for liver mobilization, resulting in a reduced risk of postoperative ascites. ASO Author Reflections is a brief invited commentary on the article ''Laparoscopic Segment 1 with Partial IVC Resection in Advanced Cirrhosis: How to Do It Safely''.