Skip to main content
SpringerLink
Log in

Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it

  • How-I-Do-It Articles
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  PubMed  Google Scholar 

  2. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han H-S, et al. (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629

    PubMed  Google Scholar 

  3. Dagher I, Caillard C, Proske J-M, Carloni A, Lainas P, Franco D (2008) Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 206(4):756–760

    Article  PubMed  Google Scholar 

  4. Ikeda T, Mano Y, Morita K, Hashimoto N, Kayashima H, Masuda A, et al. (2013) Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection. J Hepatobiliary Pancreat Sci 20(2):145–150

    Article  PubMed  Google Scholar 

  5. Rotellar F, Pardo F, Bueno A, Martí-Cruchaga P, Zozaya G (2012) Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbeck’s Arch Surg 397(3):481–485

    Article  Google Scholar 

  6. Rotellar F, Pardo F, Benito A, Martí-Cruchaga P, Zozaya G, Bellver M (2014) Laparoscopic right hepatectomy extended to middle hepatic vein after right portal vein embolization. Ann Surg Oncol 21(1):165–166

    Article  PubMed  Google Scholar 

  7. Rotellar F, Pardo F, Benito A, Marti Cruchaga P, Zozaya G, Lopez L, et al. (2013) Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety. Am J Transplant 13(12):3269–3273

    Article  CAS  PubMed  Google Scholar 

  8. Pearce NW, Di Fabio F, Teng MJ, Syed S, Primrose JN, Abu Hilal M (2011) Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg 202(5):e52–e58

    Article  PubMed  Google Scholar 

  9. Tzanis D, Shivathirthan N, Laurent A, Abu Hilal M, Soubrane O, Kazaryan AM, et al. (2014) European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci 20(2):120–124

    Article  Google Scholar 

  10. Dokmak S, Ben Safta Y, Ftériche FS, Aussilhou B, Belghiti J (2014) Pure laparoscopic right hepatectomy with the hanging maneuver for multiple hepatocellular adenomas. Ann Surg Oncol 21(12):3800–3801

    Article  PubMed  Google Scholar 

  11. Troisi RI, Montalti R (2012) Modified hanging maneuver using the goldfinger dissector in laparoscopic right and left hepatectomy. Dig Surg 29(6):463–467

    Article  PubMed  Google Scholar 

  12. Soubrane O, Perdigao Cotta F, Scatton O (2013) Pure laparoscopic right hepatectomy in a living donor. Am J Transplant 13(9):2467–2471

    Article  CAS  PubMed  Google Scholar 

  13. Bueno A, Rotellar F, Benito A, Martí-Cruchaga P, Zozaya G, Hermida J, et al. (2014) Laparoscopic limited liver resection decreases morbidity irrespective of the hepatic segment resected. HPB (Oxford) 16(4):320–326

    Article  Google Scholar 

  14. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R (2001) Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 193(1):109–111

    Article  CAS  PubMed  Google Scholar 

  15. Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J (2009) The liver hanging manoeuvre. HPB (Oxford) 11(4):296–305

    Article  Google Scholar 

  16. Takahashi M, Wakabayashi G, Nitta H, Takeda D, Hasegawa Y, Takahara T, et al. (2013) Pure laparoscopic right hepatectomy by anterior approach with hanging maneuver for large intrahepatic cholangiocarcinoma. Surg Endosc 27(12):4732–4733

    Article  PubMed  Google Scholar 

Download references

Authors’ contributions

Fernando Rotellar: Study conception and design, analysis and interpretation of data, drafting of manuscript. Fernando Pardo: Study conception and design, critical revision of manuscript. Pablo Martí-Cruchaga: Study conception and design, critical revision of manuscript. Gabriel Zozaya: Study conception and design, critical revision of manuscript. Víctor Valentí: Study conception and design, critical revision of manuscript. Manuel Bellver: Study conception and design. Luis López-Olaondo: Study conception and design, critical revision of manuscript. Francisco Hidalgo: Study conception and design, critical revision of manuscript.

Author information

Authors and Affiliations

  1. HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain

    Fernando Rotellar, Fernando Pardo, Pablo Martí-Cruchaga, Gabriel Zozaya, Victor Valentí, Manuel Bellver, Luis Lopez-Olaondo & Francisco Hidalgo

  2. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

    Fernando Rotellar, Fernando Pardo, Pablo Martí-Cruchaga, Gabriel Zozaya, Victor Valentí & Manuel Bellver

  3. Department of Anaesthesiology, University Clinic, Universidad de Navarra, Pamplona, Spain

    Luis Lopez-Olaondo & Francisco Hidalgo

Authors
  1. Fernando Rotellar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando Pardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pablo Martí-Cruchaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriel Zozaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Victor Valentí
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manuel Bellver
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luis Lopez-Olaondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francisco Hidalgo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Rotellar.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

This video shows how the patient positioning herein described helps in the mobilization of the right hemiliver for laparoscopic right hepatectomy and in the preparation of liver hanging maneuver.

(M4 V 60044 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rotellar, F., Pardo, F., Martí-Cruchaga, P. et al. Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it. Langenbecks Arch Surg 402, 181–185 (2017). https://doi.org/10.1007/s00423-016-1473-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1473-5

Keywords

Search

Navigation