Abstract
Background
The liver hanging maneuver (LHM) was described by Belghiti et al. to facilitate liver resection and is done classically by creating a space between the caudate lobe and the inferior vena cava starting on the edge of caudate lobe and extending cranially, in a para-caval fashion, towards the space between the right and middle hepatic veins. LHM facilitates liver transection, guides anatomical resections, decreases blood loss, facilitates harvesting of the liver graft in live donors, and also has oncological advantages.
Study design
We describe a new approach named “up-to-down” to perform LHM in open and laparoscopic liver resections. This approach was mainly used in obese patients, in laparoscopic liver resections and in cases of failure of the classic approach. The advantages/disadvantages, complications, and different modalities of LHM are also summarized.
Results
The peritoneal layer between the liver capsule and the infrahepatic vena cava is opened, and a short blind dissection is initiated on the right anterolateral aspect of the inferior vena cava to the left of the hepatic vein of segment VI. The suprahepatic vena cava is exposed, and the space between the right and middle hepatic veins and the vena cava is created by gentle dissection. A 16-Fr nasogastric tube is positioned in the space between the right and middle hepatic vein, pointing inferiorly, and pushed downwards, in a para-caval manner caudally until it is seen inferiorly. The results of this approach are given.
Conclusion
LHM facilitates liver resection, and many variations have been described worldwide in open and laparoscopic liver surgery. The up-to-down approach should be part of the surgical armamentarium in order to offer a safer way to achieve LHM in some patients.
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Abbreviations
- LHM:
-
Liver hanging maneuver
- LHM:
-
IVC Inferior vena cava
References
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
Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F, Sauvanet A (2007) Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 245(1):31–35
Liu CL, Fan ST, Cheung ST, Lo CM, Ng IO, Wong J (2006) Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg 244(2):194–203
Li H, Zhu B, Huang J et al (2018) Liver hanging maneuver versus conventional approach for open hepatectomy: a meta-analysis. HPB (Oxford)
Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Yoshida K, Fujiwara T (2013) Bloodless donor hepatectomy in living donor liver transplantation: counterclockwise liver rotation and early hanging maneuver. J Gastrointest Surg 17(1):203–206
Shindoh J, Aoki T, Hasegawa K, Beck Y, Sugawara Y, Makuuchi M, Kokudo N (2012) Donor hepatectomy using hanging maneuvers: Tokyo University experiences in 300 donors. Hepatogastroenterology. 59(118):1939–1943
Kim SH, Kim YK (2012) Living donor right hepatectomy using the hanging maneuver by Glisson’s approach under the upper midline incision. World J Surg 36(2):401–406
Vennarecci G, Levi Sandri GB, Ettorre GM (2016) Performing the ALPPS procedure by anterior approach and liver hanging maneuver. Ann Surg 263(1):e11
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
Nitta H, Sasaki A, Fujita T, Itabashi H, Hoshikawa K, Takahara T, Takahashi M, Nishizuka S, Wakabayashi G (2010) Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg 251(3):450–453
Donadon M, Abdalla EK, Vauthey JN (2007) Liver hanging maneuver for large or recurrent right upper quadrant tumors. J Am Coll Surg 204(2):329–333
Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Hong EK, Kim CM (2007) Various liver resections using hanging maneuver by three glisson's pedicles and three hepatic veins. Ann Surg 245(2):201–205
Nanashima A, Tobinaga S, Araki M, Nonaka T, Abo T, Hidaka S, Takeshita H, Sawai T, Nagayasu T (2009) Double liver hanging manoeuvre for central hepatectomy. HPB (Oxford) 11(6):529–531
Perini MV, Coelho FF, Kruger JA, Rocha FG, Herman P (2016) Extended right hepatectomy with caudate lobe resection using the hilar “en bloc” resection technique with a modified hanging maneuver. J Surg Oncol 113(4):427–431. https://doi.org/10.1002/jso.24154
Chowdappa R, Sagar RC, Ramesh S, Appaji L, Maneya P, Mukundapai M (2019) Central hepatectomy (mesohepatectomy) by double liver hanging maneuver (DLHM) in a child with hepatoblastoma. Indian J Surg Oncol 10(1):46–49
Kim JH, Cho BS, Jang JH (2018) Pure laparoscopic anatomical segment VI resection using the Glissonian approach, Rouviere's sulcus as a landmark, and a modified liver hanging maneuver (with video). Langenbeck's Arch Surg 403(1):131–135
Chu H, Cao G, Tang Y, Du X, Min X, Wan C (2018) Laparoscopic liver hanging maneuver through the retrohepatic tunnel on the right side of the inferior vena cava combined with a simple vascular occlusion technique for laparoscopic right hemihepatectomy. Surg Endosc 32(6):2932–2938
Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J (2009) The liver hanging manoeuvre. HPB (Oxford) 11(4):296–305
Tanaka K, Wakabayashi T (2020) Cautions concerning hanging maneuvers during hepatobiliary pancreatic surgery. Surgery. 167(2):516
Wu TJ, Wang F, Lin YS, Chan KM, Yu MC, Lee WC (2010) Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br J Surg 97(7):1070–1078
Beppu T, Imai K, Okuda K, Eguchi S, Kitahara K, Taniai N, Ueno S, Shirabe K, Ohta M, Kondo K, Nanashima A, Noritomi T, Shiraishi M, Takami Y, Okamoto K, Kikuchi K, Baba H, Fujioka H (2017) Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi-institutional propensity score-matching study. J Hepatobiliary Pancreat Sci 24(3):127–136
Llado L, Muñoz A, Ramos E, Torras J, Fabregat J, Rafecas A (2016) The anterior hanging-approach improves postoperative course after right hepatectomy in patients with colorectal liver metastases. Results of a prospective study with propensity-score matching comparison. Eur J Surg Oncol 42(2):176–183
Troisi RI, Montalti R (2012) Modified hanging maneuver using the goldfinger dissector in laparoscopic right and left hepatectomy. Dig Surg 29(6):463–467
Takahashi M, Wakabayashi G, Nitta H, Takeda D, Hasegawa Y, Takahara T, Ito N (2013) Pure laparoscopic right hepatectomy by anterior approach with hanging maneuver for large intrahepatic cholangiocarcinoma. Surg Endosc 27(12):4732–4733
Casaccia M, Andorno E, Di Domenico S et al (2012) Laparoscopic right posterior sectionectomy for hepatocellular carcinoma using a modified liver-hanging maneuver. J Laparoendosc Adv Surg Tech A 22(5):488–491
Kim JH (2017) Modified liver hanging maneuver focusing on outflow control in pure laparoscopic left-sided hepatectomy. Surg Endosc 25
Rhaiem R, Piardi T, Kellil T, Cagniet A, Chetboun M, Kianmanesh R, Sommacale D (2018) The liver hanging maneuver in laparoscopic liver resection: a systematic review. Surg Today 48(1):18–24
Kim JH, Kim H (2020) Modified liver hanging maneuver in laparoscopic major hepatectomy: the learning curve and evolution of indications. Surg Endosc 34(6):2742–2748
Kim JH (2019) Three-dimensional ventral approach with the modified liver-hanging maneuver during laparoscopic right hemihepatectomy. Ann Surg Oncol 26(7):2253
Mizuguchi T, Kawamoto M, Meguro M, Okita K, Nishidate T, Furuhata T, Hui TT, Hirata K (2014) Saline injection method for facilitating the liver hanging maneuver during hepatectomy for a large right liver tumor. J Am Coll Surg 219(2):e11–e14
Chu H, Cao G, Tang Y et al (2017) Laparoscopic liver hanging maneuver through the retrohepatic tunnel on the right side of the inferior vena cava combined with a simple vascular occlusion technique for laparoscopic right hemihepatectomy. Surg Endosc
Farges O, Goutte N, Dokmak S et al (2014) For the ACHBT French hepatectomy study group. How surgical technology translates into practice: the model of laparoscopic liver resections performed in France. Ann Surg
Dokmak S, Meniconi RL, Aussilhou B (2017) Laparoscopic left hepatectomy with hanging maneuver for hepatocellular carcinoma with thrombectomy of the left portal vein (with video). J Visc Surg 154(3):213–215
Ettorre GM, Vennarecci G, Santoro R, Boschetto A, Miglioresi L, Corazza V, Mancini P, Lorusso R, Spoletini D, Antonini M, Tacconi G, Santoro E (2007) Modified liver hanging maneuver during orthotopic liver transplantation with inferior vena cava preservation: results after 120 consecutive applications. Transplant Proc 39(6):1881–1882
Pessaux P, Rosso E, Panaro F, Marzano E, Oussoultzoglou E, Bachellier P, Jaeck D (2009) Preliminary experience with the hanging maneuver for pancreaticoduodenectomy. Eur J Surg Oncol 35(9):1006–1010
Dokmak S, Aussilhou B, Ftériche FS, Belghiti J, Sauvanet A (2017) Hanging maneuver for stomach traction in laparoscopic distal pancreatic resections: an original technique applied in 218 patients. Dig Surg 34(2):89–94
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Dokmak, S., Aussilhou, B., Rebai, W. et al. Up-to-down open and laparoscopic liver hanging maneuver: an overview. Langenbecks Arch Surg 406, 19–24 (2021). https://doi.org/10.1007/s00423-020-01945-5
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DOI: https://doi.org/10.1007/s00423-020-01945-5