The purpose of this study is to describe a technical modification that facilitates right liver mobilization in laparoscopic right hepatectomy (LRH).
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.
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.
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.
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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.
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)
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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) doi:10.1007/s00423-016-1473-5
- Liver mobilization, right liver
- Laparoscopic hepatectomy
- Right hepatectomy