Modified liver hanging maneuver to facilitate left hepatectomy and caudate lobe resection for hilar bile duct cancer.
The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, but it has several technical limitations for resection of the hepatic paracaval portion. We present a modified LHM that facilitates concurrent resection of the paracaval portion, a technique applicable to left liver resection for hilar bile duct (HBD) cancers. During 11 months from November 2006 to September 2007, 10 HBD cancer patients underwent left liver resection using the modified LHM. This method included initial partial transection of the caudal paracaval portion. Thus, subsequent blind tunneling over the retrohepatic inferior vena cava can become as short as 2-3 cm in length, resulting in effective prevention of short hepatic vein injury. The parenchyma transection plane was tailored to remove most of the paracaval portion. This modified LHM technique was safely and effectively applied to 10 consecutive patients, requiring a shorter time than conventional dissection method for caudate lobe dissection. No significant bleeding occurred during retrohepatic tunneling. The final parenchymal transection plane after left liver resection using modified LHM was the same as that following the conventional surgical technique for HBD cancers. In conclusion, we think that this modified LHM is an effective, technically simple procedure for resection of the left liver and caudate lobe in HBD patients.
Hwang
Shin
S
Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. shwang@amc.seoul.kr
Lee
Sung-Gyu
SG
Lee
Young-Joo
YJ
Kim
Ki-Hun
KH
Ahn
Chul-Soo
CS
Kim
Kwan-Woo
KW
Ko
Kyoung-Hoon
KH
Choi
Nam-Kyu
NK
D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome