title: Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it.
abstract: OBJECTIVE
  The purpose of this study is to describe a technical modification that facilitates right liver mobilization in laparoscopic right hepatectomy (LRH).
  
  
  METHODS
  In the supine position, an inflatable device is placed under the patient's right chest. For right hemiliver mobilization, the table is placed in 30° anti-Trendelenburg and full-left tilt. Balloon inflation offers an additional 30° left inclination that places the patient in an almost left lateral position. Foot and lateral supports are placed to prevent patient slippage during changes in the patient positioning.
  
  
  RESULTS
  From December 2013 to October 2015, this technique has been used in 10 consecutive LRH. The indications for these procedures were as follows: four donor hepatectomies for living donor liver transplant, three hepatocellular carcinomas and one peripheral cholangiocarcinoma in cirrhotic patients, one hepatocellular carcinoma in a non-cirrhotic patient, and one case of colorectal cancer metastases. In this period, it has also been used to facilitate mobilization and resection in the posterior segments of the liver in seven patients. In every case, right hemiliver mobilization was easily performed in a maximum time of 15 min and placement of a tape or plastic tube for liver hanging was prepared. We have not observed any complication directly attributable to the technique herein described (i.e. right brachialgia; arms, back or left flank pain) in the early or late postoperative follow-up.
  
  
  CONCLUSIONS
  The additional left inclination obtained with the inflation of a balloon under the right chest facilitates right hemiliver mobilization. Its use may help in the performance and adoption of LRH.
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain. frotellar@unav.es.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain. frotellar@unav.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martí-Cruchaga
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zozaya
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Valentí
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bellver
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Department of Anaesthesiology, University Clinic, Universidad de Navarra, Pamplona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Lopez-Olaondo
authors.affiliation: HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain.|Department of Anaesthesiology, University Clinic, Universidad de Navarra, Pamplona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hidalgo
mesh_terms: D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D056888:Patient Positioning
keywords: Laparoscopic hepatectomy; Laparoscopy; Liver mobilization, right liver; Right hepatectomy