Laparoscopic Resection of Caudate Lobe Liver Tumors in Clinical Practice

ABSTRACT The caudate lobe (Couinaud segment I), owing to its deep location in the posterosuperior liver, intimate encirclement by the inferior vena cava (IVC), and close adjacency to the hepatic hilum and major hepatic veins, presents a formidable anatomical challenge for resection. Laparoscopic techniques, with their capacity for magnified, multi‐angled visualization, confer distinct advantages in navigating this complex region. The primary surgical approaches—the left‐side approach (optimal for the Spiegel lobe), the right‐side approach (suitable for the caudate process), and anterior transhepatic approach (providing direct access)—are selected based on tumor topography with combined strategies reserved for extensive lesions. Despite this methodological diversity, all laparoscopic caudate lobectomies are governed by common principles: (1) the indispensability of meticulous preoperative 3D imaging planning, (2) the critical need for systematic control of the short hepatic veins and hilar structures to mitigate hemorrhage risk, (3) the imperative of a stepwise, precise dissection technique to ensure safe pedicle isolation, and (4) the strategic utility of a combined major hepatectomy (e.g., with left or right hemihepatectomy) to simplify complex cases. Mastery of these approaches and strict adherence to these principles are paramount for achieving oncological radicality while maximizing the preservation of functional hepatic parenchyma in this high‐risk surgery.