Isolated Resection of Segment I (Caudate Lobe): Is it Justified?

Background: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed. Methods: Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularised by Pringle's maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava. Results: Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction. Conclusions: This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.