Arantius Ligament Suspension: A Novel Technique for Retraction of the Left Lateral Lobe Liver During Laparoscopic Isolated Caudate Lobectomy

Background: Laparoscopic isolated caudate lobectomy remains a challenging procedure because of its deep location and proximity to the important vessels. We present a novel technique, Arantius ligament suspension, which could improve operative field exposure in laparoscopic isolated caudate lobectomy through retraction of the left lateral lobe liver. Materials and Methods: The Arantius ligament suspension technique was performed in 6 selected patients during laparoscopic isolated caudate lobectomy in our center: 2 with symptomatic hepatic cavernous hemangioma and 4 with hepatocellular carcinoma (HCC). The Arantius ligament suspension technique was performed using a 2-0 polypropylene suture (Prolen2-0((R)); Ethicon, Somerville, NJ), which was secured to the Arantius ligament with surgical clips at its halfway point and the left lateral lobe of liver would be retracted toward the abdominal wall when the suture was tightened. Perioperative data of these patients and follow-up data of HCC patients were retrospectively reviewed. Results: All 6 procedures were completed without conversion to open surgery or requiring additional ports. The mean tumor size was 5.4cm (2.2-7.8cm), the mean blood loss was 260mL (50-440mL), and no patients required blood transfusion during the operation. The mean time required for this technique was 2 minutes 5 seconds (1 minutes 36 seconds-2 minutes 44 seconds) and the mean duration of entire surgery was 249 minutes (173-300 minutes). The mean postoperative hospital stay was 7 days (5-9 days) and no postoperative complication related to the suspension procedure occurred. Conclusions: Our outcomes demonstrated the Arantius ligament suspension technique is a feasible and ideal method during laparoscopic isolated caudate lobectomy for providing a rapid and safe left lateral lobe retraction.