Abstract
Purpose
We evaluated the efficiency of a modified liver-hanging technique for minimizing intraoperative blood loss during right and left hemihepatectomy.
Methods
The lower end of the hanging tape was repositioned between the parenchyma of the left paramedian sector and the hilar plate. The upper end of the tape was positioned between the right hepatic vein and middle hepatic vein for right hepatectomy (Belghiti), and between the middle hepatic vein and left hepatic vein for left hepatectomy. The tape was positioned prior to the parenchymal transection. We compared the results of this operative technique, performed in 15 recent patients, with those of conventional hemihepatectomy performed in 14 earlier patients.
Results
There were no intergroup differences in baseline characteristics or postoperative outcomes. Intraoperative blood loss (P = 0.02), especially blood loss during the parenchymal transection (P = 0.005), was significantly less in patients undergoing the modified technique. Multivariate analysis revealed that this modified liver-hanging technique offered a significant advantage in blood-loss reduction during parenchymal transection over the conventional techniques (P = 0.005).
Conclusion
Using the liver-hanging technique during hemihepatectomy could be crucial for liver surgeons.
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References
Sitzmann JV, Greene PS. Perioperative predictors of morbidity following hepatic resection for neoplasm. A multivariate analysis of a single surgeon experience with 105 patients. Ann Surg 1994;219:13–17.
Heriot AG, Karanjia ND. A review of techniques for liver resection. Ann R Coll Surg Engl 2002;84:371–380.
Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001;193:109–111.
Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F, et al. Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 2007;245:31–35.
Lai EC, Fan ST, Lo CM, Chu KM, Liu CL. Anterior approach for difficult major right hepatectomy. World J Surg 1996;20:314–317.
Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Sling suspension of the liver in donor operation: a gradual taperepositioning technique. Transplantation 2003;76:803–807.
Ettorre GM, Vennarecci G, Boschetto A, Douard R, Santoro E. Feasibility of hanging maneuvers in orthotopic liver transplantation with inferior vena cava preservation and in liver surgery. J Hepatobiliary Pancreat Surg 2004;11:155–158.
Suzuki M, Unno M, Katayose Y, Takeuchi H, Rikiyama T, Onogawa T, et al. Hepatic resection through an anterior approach employing a modified liver hanging maneuver in patients with a massive liver tumor severely oppressing the inferior vena cava. Hepatogastroenterology 2004;51:1459–1463.
Suh KS, Lee HJ, Kim SH, Kim SB, Lee KU. Hanging maneuver in left hepatectomy. Hepatogastroenterology 2004;51:1464–1466.
Kokudo N, Imamura H, Sano K, Zhang K, Hasegawa K, Sugawara Y, et al. Ultrasonically assisted retrohepatic dissection for a liver hanging maneuver. Ann Surg 2005;242:651–654.
Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Hong EK, et al. Various liver resections using hanging maneuver by three Glisson’s pedicles and three hepatic veins. Ann Surg 2007;245:201–205.
Donadon M, Abdalla EK, Vauthey JN. Liver hanging maneuver for large or recurrent right upper quadrant tumors. J Am Coll Surg 2007;204:329–333.
Takatsuki M, Kawashita Y, Eguchi S, Tajima Y, Kanematsu T. Tape-guided living donor left hepatectomy. Am J Surg 2007;194:107–109.
Nanashima A, Sumida Y, Abo T, Nagayasu T, Sawai T. Usefulness and application of the liver hanging maneuver for anatomical liver resections. World J Surg 2008;32:2070–2076.
Tanaka H, Takemura S, Ohba K, Hai S, Ichikawa T, Kodai S, et al. Convenience of a tape-guiding technique in different types of hepatectomy. Hepatogastroenterology 2008;55:160–163.
Lai PB, Wong J, Ng WW, Lee WL, Cheung YS, Tsang YY, et al. Safe modification of the liver-hanging maneuver by endoscopicassisted dissection of the retrohepatic tunnel. Surg Today 2007;37:915–917.
Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, et al. Surgery for small liver cancers. Semin Surg Oncol 1993;9:298–304.
Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg 1995;169:589–594.
Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997;26:1176–1181.
Johnson M, Mannar R, Wu AV. Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg 1998;85:188–190.
Gaujoux S, Douard R, Ettorre GM, Delmas V, Chevallier JM, Cugnenc PH. Liver hanging maneuver: an anatomic and clinical review. Am J Surg 2007;193:488–492.
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Akamatsu, N., Sugawara, Y., Shin, N. et al. Modified liver-hanging maneuver designed to minimize blood loss during hepatic parenchymal transection in hemihepatectomy. Surg Today 40, 239–244 (2010). https://doi.org/10.1007/s00595-008-4060-8
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DOI: https://doi.org/10.1007/s00595-008-4060-8