Pure neural leprosy, defined as a peripheral neuropathy in which the patient has no skin lesions, is difficult to diagnose. Its verification by bacteriological index and histopathology is not possible in the majority of the patients.We describe four cases of pure neural leprosy diagnosed by clinical criteria. The clinical outcome of three of the patients after specific treatment was satisfactory, while the other one developed progressive neural damage despite the therapy. All patients were treated in a specialized center for the management and control of Hansen's disease in the municipality of Contratación, Santander, Colombia.
Results: The patient is positioned supine with split leg table. Standard laparoscopic cholecystectomy port locations were used. The gastrohepatic ligament was incised. The caudate lobe was grasped and retracted cephalad and anteriorly. Draining hepatic veins into the IVC were carefully ligated with a laparoscopic bipolar energy device. The lobe was then retracted toward the patient's left and the ligamentum venosum was ligated. Parenchymal transection was completed with waterjet dissection. The main portal vein supply was ligated with clips. The caudate lobe was freed of remaining attachments and removed in a bag. Conclusion: If care is taken, caudate lobectomy can be performed safely in minimally invasive fashion. Use of waterject dissection can mitigate risk of injury to the IVC with ultrasonic dissection device. Meticulous surgical planning is required to ensure successful and safe completion.
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