title: Extended right hepatectomy in a liver with a non-bifurcating portal vein: the hanging maneuver protects the portal system in the presence of anomalies.
abstract: BACKGROUND
  Variations in portal vein anatomy occur in 20-35 % of individuals. A non-bifurcating portal vein (PV) was suspected on preoperative imaging in a patient with a large right lobe hepatocellular carcinoma. The single PV curved within the liver parenchyma from right to left supplying second-order branches along its course.
  
  
  METHODS
  Utilizing the hanging maneuver, an extended right hemihepatectomy was safely performed. This approach allowed for preservation of the main PV and its left-sided branches while easily identifying the second-order right branches for ligation.
  
  
  CONCLUSIONS
  Knowledge of portal vein variations and identification preoperatively by cross-sectional imaging are critical. The hanging maneuver aids in the preservation of the main portal vein and its left-sided branches during right hemihepatectomy in the presence of portal vein anomalies, and this technique can be used to improve safety in hepatobiliary surgery.
authors: Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors: Ser Yee
authors: SY
authors: Lee
authors: Daniel
authors: D
authors: Cherqui
authors: Michael D
authors: MD
authors: Kluger
mesh_terms: D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography
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