title: The liver hanging manoeuvre.
abstract: The liver hanging manoeuvre (LHM) facilitates the anterior approach (AA), which is one of the most important innovations in the field of major hepatic resections. The AA confers some definite advantages over the classical approach, in that it provides for: less haemorrhage; less tumoral manipulation and rupture; better haemodynamic stability by avoiding any twisting of the inferior vena cava; reduced ischaemic damage of the liver remnant, and better survival for patients with hepatocellular carcinoma (HCC). The LHM makes the AA easier because it serves as a guide to the correct anatomical transection plane and elevates the deep parenchymal plane. The LHM is a safe technique, in which minor complications have been reported in < or = 7% of patients and >90% feasibility has been demonstrated in experienced centres. Over the years, different variants of the LHM have been developed to facilitate almost all anatomical liver resections. In view of its advantages, feasibility and safety, the LHM should be considered for most anatomical hepatectomies.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Beaujon Hospital-University Denis Diderot Paris, Assistance Publique-Hôpitaux de Paris, Clichy, France.
authors.forename: Guido
authors.initials: G
authors.lastname: Liddo
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Buc
authors.forename: Ganesh
authors.initials: G
authors.lastname: Nagarajan
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti