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The “Tenting Sign of the Hepatic Vein” Is Important for Laparoscopic Anatomical Hepatectomy Along the Major Hepatic Vein

  • Naokazu ChibaEmail author
  • Yuta Abe
  • Masashi Nakagawa
  • Itsuki Koganezawa
  • Kei Yokozuka
  • Toshimichi Kobayashi
  • Kosuke Hikita
  • Yosuke Ozawa
  • Toru Sano
  • Koichi Tomita
  • Rina Tsutsui
  • Shigeyuki Kawachi
Multimedia Article
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Abstract

Background

Laparoscopic hepatectomy has rapidly evolved and has become a viable alternative to open hepatectomy. However, the dissection of liver parenchyma via the laparoscopic caudal approach (parenchymal transection from the caudal to cranial direction under a laparoscopic caudal view) has several limitations. To avoid these limitations in anatomical hepatectomy along the hepatic vein with the caudal approach, it is important to recognize the “tenting sign of the hepatic vein,” which helps to identify the running of the main trunk of the hepatic vein.

Technical Presentation

In the bifurcation of the hepatic vein, there is a possibility of splitting of the hepatic vein branch or disorientation between the main trunk and branch. Therefore, it is vital that when the branch is pulled, the main trunk of the hepatic vein appears to be toward the direction of the branch. As a result, the main trunk appears in the direction from the original route to the pseudo route. In the caudal approach, this phenomenon is called “tenting sign of the hepatic vein.” Therefore, liver dissection should be performed in the contralateral and cranial sides of the main trunk, with the “tenting sign of the hepatic vein” in mind. This report describes specific cases of the “tenting sign of the hepatic vein.”

Conclusion

The “tenting sign of the hepatic vein” from the caudal approach is essential knowledge for safe and reliable anatomical laparoscopic hepatectomy and can lead to expansion of indications in the future.

Keywords

Tenting sign of the hepatic vein Laparoscopic anatomical hepatectomy 

Notes

Authors’ Contributions

Naokazu Chiba wrote the paper. Naokazu Chiba, Yuta Abe, and Shigeyuki Kawachi were involved with study conception and design. All authors were involved with acquisition, analysis, and interpretation of data.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© The Society for Surgery of the Alimentary Tract 2020

Authors and Affiliations

  • Naokazu Chiba
    • 1
    Email author
  • Yuta Abe
    • 2
  • Masashi Nakagawa
    • 1
  • Itsuki Koganezawa
    • 1
  • Kei Yokozuka
    • 1
  • Toshimichi Kobayashi
    • 1
  • Kosuke Hikita
    • 1
  • Yosuke Ozawa
    • 1
  • Toru Sano
    • 1
  • Koichi Tomita
    • 1
  • Rina Tsutsui
    • 1
  • Shigeyuki Kawachi
    • 1
  1. 1.Department of Digestive and Transplantation SurgeryTokyo Medical University Hachioji Medical CenterHachiojiJapan
  2. 2.Department of SurgeryKeio University School of MedicineShinjuku-kuJapan

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