| During a laparoscopic hepatectomy, which is performed in the caudodorsal view, the dorsal midline, which is parallel to the ventral aspect of the inferior vena cava (IVC), need not be divided in the final stage, because it is clearly visible and can be divided from the back in a clear magnified view. We have standardized the caudate lobe first approach, in which the caudate lobe located between the Glissonean trunk of the right main (G-right) or right posterior (G-post) and IVC is divided in the dorsal midline, and then, the posterior aspect of the G-right or post is exposed during the first stage of the liver dissection. Furthermore, anatomically, the origins of the Glissonean branches and hepatic veins are located on the dorsal side of the liver, and they branch similar to a tree, extending toward the ventral (peripheral) side. Therefore, by dissecting the liver from the caudal side toward the cranial side and moving the devices from the dorsal side toward the ventral side, parenchymal dissection can be easily performed along the intersegmental plane, avoiding a split injury of the hepatic vein branches. Thus, the caudate lobe first approach makes laparoscopic hepatectomy safer and more precise and provides true advantages of the laparoscopic approach. We present our procedures of laparoscopic anatomical hepatectomies using the caudate lobe first approach. |
