title: Modified liver hanging maneuver with extraparenchymal isolation of the middle hepatic vein in left hepatectomy.
abstract: OBJECTIVE
  The liver hanging maneuver has been employed mostly for right hepatectomy. After the space between the inferior vena cava and the liver parenchyma is bluntly dissected, a tape is passed through the space, with the upper end of the tape between the right hepatic vein and middle hepatic vein (MHV). We devised a modified maneuver with tape repositioning between the MHV and left hepatic vein (LHV) after extraparenchymal isolation of the MHV, in left hepatectomy with the caudate lobe and without the MHV.
  
  
  METHODS
  The ligamentum venosum is divided. Traction of the cranial stump of the ligament in the cranial and left direction shows an avascular plane between the LHV and MHV, and enables the taping of each MHV and LHV. Finally, the upper end of the hanging tape is repositioned.
  
  
  RESULTS
  This maneuver was successfully performed in three patients.
  
  
  CONCLUSIONS
  The present maneuver is feasible and useful in left hepatectomy.
authors.affiliation: Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. sgym@kyorin-u.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Masaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mori
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery