title: Safe modification of the liver-hanging maneuver by endoscopic-assisted dissection of the retrohepatic tunnel.
abstract: 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.
authors: 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.
authors: Paul B S
authors: PB
authors: Lai
authors: John
authors: J
authors: Wong
authors: Wilson W C
authors: WW
authors: Ng
authors: Wai-Lun
authors: WL
authors: Lee
authors: Yue-Sun
authors: YS
authors: Cheung
authors: Yvonne Y Y
authors: YY
authors: Tsang
authors: Kit-Fai
authors: KF
authors: Lee
mesh_terms: D004210:Dissection; D016145:Endoscopy, Digestive System; D006498:Hepatectomy; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000601:surgery*