Modified liver hanging maneuver with extraparenchymal isolation of the middle hepatic vein in left hepatectomy.
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.
Sugiyama
Masanori
M
Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. sgym@kyorin-u.ac.jp
Suzuki
Yutaka
Y
Abe
Nobutsugu
N
Masaki
Tadahiko
T
Mori
Toshiyuki
T
Atomi
Yutaka
Y
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