title: Hepatic resection using a liver-hanging maneuver and Glissonean pedicle transection for hepatocellular carcinoma in a patient with situs inversus totalis: report of a case.
abstract: Situs inversus totalis is a rare congenital anomaly in which the major abdominal organs are located as a mirror image of their normal positions. This poses much difficulty for surgeons. We describe how we performed the liver-hanging maneuver (LHM) for hepatocellular carcinoma (HCC) in a 59-year-old man with situs inversus totalis, to resolve the difficulty of the mirror-image location of his liver. The HCC was located in the right lateral sector. Although segmentectomy of segment 7 would normally be considered minimal for a curative treatment of HCC, this was relatively complicated in this patient. Thus, we performed an extended right lateral sectionectomy using the LHM to achieve a simple transection. The hepatic hilum was dissected using the Glissonean pedicle transection method. The operation time and intraoperative blood loss were 6 h 45 min and 471 ml, respectively. No blood product transfusion was required. The LHM and the hilar Glissonean pedicle approach proved effective for resolving the difficulties of performing surgery in a mirror image for HCC in a patient with situs inversus totalis.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto, Kumamoto, 860-8556, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Harada
authors.forename: Toshiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Ryu
authors.initials: R
authors.lastname: Otao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012857:Situs Inversus / Q000150:complications*