Anatomical basis of the liver hanging maneuver.
OBJECTIVE
The anterior approach to right hepatectomy using the liver hanging maneuver without liver mobilization claims to be anatomically evaluated. During this procedure a 4 to 6-cm blind dissection between the inferior vena cava and the liver is performed. Short subhepatic veins, entering the inferior vena cava could be torn and a hemorrhage, difficult to control, could occur.


METHODS
On 100 corrosive casts of livers the anterior surface of the inferior vena cava was studied to evaluate the position, diameter and draining area of short subhepatic veins and inferior right hepatic vein. The width of the narrowest point on the planned route of blind dissection was determined.


RESULTS
The average value of the narrowest point on the planned route of blind dissection was 8.7+/-2.3mm (range 2-15mm). The ideal angle of dissection being 0 degrees was found in 93% of cases. In 7% we found the angle of 5 degrees toward the right border of inferior vena cava to be the better choice.


CONCLUSIONS
Our results show that liver hanging maneuver is a safe procedure. With the dissection in the proposed route the risk of disrupting short subhepatic veins is low (7%).
Trotovsek
Blaz
B
Institute of Anatomy, Medical Faculty Ljubljana, Slovenia.
Belghiti
Jacques
J
Gadzijev
Eldar M
EM
Ravnik
Dean
D
Hribernik
Marija
M
D016319:Corrosion Casting; D004210:Dissection / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000293:injuries; D006801:Humans; D007049:Iatrogenic Disease; D012307:Risk Factors; D014682:Vena Cava, Inferior / Q000033:anatomy & histology* / Q000293:injuries