Safe modification of the liver-hanging maneuver by endoscopic-assisted dissection of the retrohepatic tunnel.
As a safer approach to right hepatectomy, Belghiti et al. (J Am Coll Surg 193:109-11, 2001) described a liver-hanging maneuver. However, this procedure is performed blind, with the risks of damaging the small retrohepatic veins and consequential bleeding. To overcome this problem, we modified the procedure so that, instead of performing blind dissection using a long vascular clamp, we use a flexible choledochoscope to dissect the retrohepatic space filled by loose alveolar tissue anterior to the inferior vena cava (IVC). The avascular path is identified by a combination of saline irrigation and gentle movement of the tip of the choledochoscope. Cotton tape can then be passed around the liver parenchyma to elevate the liver away from the anterior surface of the IVC. This modification of Belghiti's liver-hanging maneuver allows direct vision along the plane anterior to the IVC, thus avoiding injury to the retrohepatic veins.
Lai
Paul B S
PB
Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
Wong
John
J
Ng
Wilson W C
WW
Lee
Wai-Lun
WL
Cheung
Yue-Sun
YS
Tsang
Yvonne Y Y
YY
Lee
Kit-Fai
KF
D004210:Dissection; D016145:Endoscopy, Digestive System; D006498:Hepatectomy; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000601:surgery*