title: Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding.
abstract: OBJECTIVE
  Although laparoscopic liver resection has been widely adopted, performing a pure laparoscopic right hepatectomy remains a challenging procedure. The aim of this report is to evaluate the efficiency of a pure laparoscopic right hepatectomy (PLRH) in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver.
  
  
  METHODS
  Pure laparoscopic right hepatectomy was performed in the semi-prone position with the use of an intrahepatic Glissonian approach and modified hanging maneuver for patients with primary liver cancer (n = 3) and metastatic liver cancer (n = 1).
  
  
  RESULTS
  The intraoperative total blood loss was only 95-140 g (mean: 126.2 g). None of the patients required a blood transfusion, and no serious complications were encountered. The durations of the surgeries ranged from were 308 to 445 min (mean: 394.8 min). The postoperative hospital stay was 8-11 days (mean 9.5 days).
  
  
  CONCLUSIONS
  Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver is thus considered to be a safe modality, which minimizes intraoperative bleeding.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Ueda
authors.forename: Akira
authors.initials: A
authors.lastname: Kabashima
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Hideki
authors.initials: H
authors.lastname: Ijichi
authors.forename: Yosihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsujitani
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016684:Prone Position