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Histological basis of the liver hanging maneuver

  • Anatomic Bases of Medical, Radiological and Surgical Teaching Anatomy
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Abstract

Background

Liver hanging maneuver (LHM) consists in passing a tape between the retrohepatic inferior vena cava (RHIVC) and the liver to perform various kinds of hepatectomies. LHM is a well-known procedure but its histological basis remains poorly documented.

Methods

Ten anatomical specimens comprising RHIVC, and surrounding hepatic parenchyma were studied after conventional staining and immunohistochemistry with specific antibody for alpha smooth muscle actin.

Results

RHIVC wall structure consists of a thick muscular layer of longitudinal smooth muscle fibers and a peripheral loose connective tissue without smooth muscle fibers adherent to the liver parenchyma. This loose connective tissue between the liver and the RHIVC is the avascular plane for the passage of the clamp during LHM.

Conclusion

The histological structure of the RHIVC does not seem to have any special hemostatic property. The low bleeding rate during LHM can be only explained by the very low density of RHIVC afferent veins.

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Acknowledgments

This work was supported by a grant from the Fonds d’Etude et de Recherche du Corps Medical—APHP, and the Association Benoit Malassagne. The authors would like to thank Pierre Ratier for his help in the preparation of manuscript, and all the staff of Ecole de Chirurgie with particular attention to René Gicquelet, Daniel Antonius, Jean-Louis Ahizi, Nicolas Royer, Bernard Quinta, Luciane Coindet and Djamel Taleb.

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Authors and Affiliations

  1. Paris Institute of Anatomy, Paris Descartes University, Paris, France

    Sebastien Gaujoux, Jean-Marc Chevallier, Vincent Delmas & Richard Douard

  2. Ecole de Chirurgie, Assistance Publique-Hôpitaux de Paris, Paris, France

    Sebastien Gaujoux

  3. Départment d’histologie, Hôpital Saint Vincent de Paul, Assistance Publique-Hôpitaux de Paris, Paris, France

    Patrick Barbet

  4. Department of General Surgery and Transplantation, San Camillo Forlanini Hospital, Rome, Italy

    Giuseppe Maria Ettorre

  5. Unité de Chirurgie Digestive et Endocrinienne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27, rue du Faubourg Saint Jacques, 75679, Paris, France

    Richard Douard

Authors
  1. Sebastien Gaujoux
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  2. Patrick Barbet
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  3. Giuseppe Maria Ettorre
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  4. Jean-Marc Chevallier
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  5. Vincent Delmas
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  6. Richard Douard
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Correspondence to Richard Douard.

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Gaujoux, S., Barbet, P., Ettorre, G.M. et al. Histological basis of the liver hanging maneuver. Surg Radiol Anat 31, 205–209 (2009). https://doi.org/10.1007/s00276-008-0437-z

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  • DOI: https://doi.org/10.1007/s00276-008-0437-z

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