Histological basis of the liver hanging maneuver.
BACKGROUND
Liver hanging maneuver (LHM) consists in passing a tape between the retrohepatic inferior vena cava (RHIVC) and the liver to perform various kinds of hepatectomies. LHM is a well-known procedure but its histological basis remains poorly documented.


METHODS
Ten anatomical specimens comprising RHIVC, and surrounding hepatic parenchyma were studied after conventional staining and immunohistochemistry with specific antibody for alpha smooth muscle actin.


RESULTS
RHIVC wall structure consists of a thick muscular layer of longitudinal smooth muscle fibers and a peripheral loose connective tissue without smooth muscle fibers adherent to the liver parenchyma. This loose connective tissue between the liver and the RHIVC is the avascular plane for the passage of the clamp during LHM.


CONCLUSIONS
The histological structure of the RHIVC does not seem to have any special hemostatic property. The low bleeding rate during LHM can be only explained by the very low density of RHIVC afferent veins.
Gaujoux
Sebastien
S
Paris Institute of Anatomy, Paris Descartes University, Paris, France.
Barbet
Patrick
P
Ettorre
Giuseppe Maria
GM
Chevallier
Jean-Marc
JM
Delmas
Vincent
V
Douard
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007124:Immunoenzyme Techniques; D008099:Liver / Q000033:anatomy & histology* / Q000098:blood supply; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000033:anatomy & histology* / Q000601:surgery