title: Modified liver-hanging maneuver designed to minimize blood loss during hepatic parenchymal transection in hemihepatectomy.
abstract: OBJECTIVE
  We evaluated the efficiency of a modified liver-hanging technique for minimizing intraoperative blood loss during right and left hemihepatectomy.
  
  
  METHODS
  The lower end of the hanging tape was repositioned between the parenchyma of the left paramedian sector and the hilar plate. The upper end of the tape was positioned between the right hepatic vein and middle hepatic vein for right hepatectomy (Belghiti), and between the middle hepatic vein and left hepatic vein for left hepatectomy. The tape was positioned prior to the parenchymal transection. We compared the results of this operative technique, performed in 15 recent patients, with those of conventional hemihepatectomy performed in 14 earlier patients.
  
  
  RESULTS
  There were no intergroup differences in baseline characteristics or postoperative outcomes. Intraoperative blood loss (P = 0.02), especially blood loss during the parenchymal transection (P = 0.005), was significantly less in patients undergoing the modified technique. Multivariate analysis revealed that this modified liver-hanging technique offered a significant advantage in blood-loss reduction during parenchymal transection over the conventional techniques (P = 0.005).
  
  
  CONCLUSIONS
  Using the liver-hanging technique during hemihepatectomy could be crucial for liver surgeons.
authors.affiliation: Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Shin
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirakawa
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ozawa
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hoshino
authors.forename: Daijo
authors.initials: D
authors.lastname: Hashimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged