title: Laparoscopic right posterior sectionectomy for hepatocellular carcinoma using a modified liver-hanging maneuver.
abstract: BACKGROUND
  Posterosuperior liver segments are the most difficult locations for laparoscopy to access. This location is considered by most surgeons to be a poor indication for a laparoscopic liver resection due to the limited visualization and the difficulty of controlling bleeding. The liver-hanging maneuver (LHM) is a technique taking aim at reducing intraoperative blood loss through an open approach.
  
  
  METHODS
  We report our early experience on adopting a modified liver-hanging technique to perform a totally laparoscopic right posterior sectionectomy to remove a 5-cm hepatocellular carcinoma located in Couinaud's segments 6 and 7.
  
  
  RESULTS
  The procedure was completed laparoscopically with acceptable time of surgery and blood loss. A 3.5-cm tumor-free resection margin was achieved. The patient was discharged on postoperative Day 10 without complications. No evidence of recurrence was seen at the 12-month follow-up.
  
  
  CONCLUSIONS
  Total laparoscopic posterior sectionectomy using a modified LHM is a possible operative procedure greatly facilitating surgical manipulation. This maneuver was successfully used to mobilize the liver, to guide the hepatic transection, and to prevent bleeding. The potential advantages of this procedure should be evaluated in a comparative study on a large number of patients.
authors.affiliation: Advanced Laparoscopy Unit, General and Transplant Surgery Department, St Martino Hospital, University of Genoa, Genoa, Italy. Marco.Casaccia@unige.it
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Domenico
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santori
authors.forename: Federico
authors.initials: F
authors.lastname: Fazio
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Gelli
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged