Abstract
A resection of the caudate lobe often needs to be combined with a hemi-hepatectomy for hilar cholangiocarcinoma or a liver tumor in segment 1. To achieve complete resection of the whole caudate lobe, the cut line between the right edge of the paracaval portion and the right lateral sector should be precisely controlled. The liver-hanging maneuver (LHM) is a useful anterior approach that does not require mobilization of the remnant liver. However, the precise set-up of the cut line of the right edge has not been optimized in previous reports. We herein introduce a new modification of LHM that we named the “dorsally fixed liver-hanging maneuver” (DF-LHM) based on the results in five patients who underwent left hepatectomy combined with a total resection of segment 1. This technique provided adequate cut planes along the right edge of the caudate lobe, shortening the transection time and reducing intraoperative blood loss. The DF-LHM may represent a new key technique for this type of hepatectomy, and further applications for other anatomical resections can be modeled on the strategy.
Similar content being viewed by others
References
Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery 2005;137:148–155.
Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, et al; Japanese Association of Biliary Surgery; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Japan Society of Clinical Oncology. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg 2008;15:41–54.
Nimura Y. Radical surgery of left-sided klatskin tumors. HPB (Oxford) 2008;10:168–170.
Asahara T, Dohi K, Hino H, Nakahara H, Katayama K, Itamoto T, et al. Isolated caudate lobectomy by an anterior approach for hepatocellular carcinoma originating in the paracaval portion of the caudate lobe. J Hepatobiliary Pancreat Surg 1998;5:416–421.
Hirai I, Murakami G, Kimura W, Kanamura T, Sato I. How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study. Clin Anat 2003;16:224–232.
Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh. Liver hanging maneuver: A safe approach to right hepatectomy without liver mobilization. Am Coll Surg 2001;193:109–111.
Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J. The liver hanging manoeuvre. HPB (Oxford) 2009;11:296–305.
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.
Takatsuki M, Eguchi S, Hidaka M, Tajima Y, Kanematsu T. A secure taping technique for a liver hanging maneuver using a surgical probe. Surg Today 2008;38:1155–1156.
Lai PB, Wong J, Ng WW, Lee WL, Cheung YS, Tsang YY, et al. Safe modification of the liver-hanging maneuver by endoscopic-assisted dissection of the retrohepatic tunnel. Surg Today 2007;37:915–917.
Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Kim CM. Isolated caudate lobectomy using the hanging maneuver. Surgery 2006;139:847–850.
López-Andújar R, Montalvá E, Bruna M, Jiménez-Fuertes M, Moya A, Pareja E, et al. Step-by-step isolated resection of segment 1 of the liver using the hanging maneuver. Am J Surg 2009;198:e42–e48.
Hwang S, Lee SG, Lee YJ, Kim KH, Ahn CS, Kim KW, et al. Modified liver hanging maneuver to facilitate left hepatectomy and caudate lobe resection for hilar bile duct cancer. J Gastrointest Surg 2008;12:1288–1292.
Sato H, Sugawara Y, Yamasaki S, Shimada K, Takayama T, Makuuchi M, et al. Thoracoabdominal approaches versus inverted T incision for posterior segmentectomy in hepatocellular carcinoma. Hepatogastroenterology 2000;47:504–506.
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.
Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui AM, Sano K, et al. Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg 2001;136:922–928.
Man K, Fan ST, Ng IO, Lo CM, Liu CL, Yu WC, et al. Tolerance of the liver to intermittent pringle maneuver in hepatectomy for liver tumors. Arch Surg 1999;134:533–539.
Hawkins WG, DeMatteo RP, Cohen MS, Jarnagin WR, Fong Y, D’Angelica M, et al. Caudate hepatectomy for cancer: a single institution experience with 150 patients. J Am Coll Surg 2005;200:345–352.
Ettorre GM, Vennarecci G, Santoro R, Antonini M, Lonardo MT, Carlini M, et al. Modified liver hanging maneuver during orthotopic liver transplantation with inferior vena cava preservation. Transplantation 2003;75:247–249.
Yamanaka N, Okamoto E, Fujihara S, Kato T, Fujimoto J, Oriyama T, et al. Do the tumor cells of hepatocellular carcinomas dislodge into the portal venous stream during hepatic resection? Cancer 1992;70:2263–2267.
Suh KS, Lee HJ, Kim SH, Kim SB, Lee KU. Hanging maneuver in left hepatectomy. Hepatogastroenterology 2004;51:1464–1466.
Nanashima A, Sumida Y, Abo T, Takeshita H, Hidaka S, Sawai T, et al. Trisectionectomy for large hepatocellular carcinoma using the liver hanging maneuver. Eur J Surg Oncol 2009;35:326–330.
Nanashima A, Tobinaga S, Araki M, Nonaka T, Abo T, Hidaka S, et al. Double liver hanging manoeuvre for central hepatectomy. HPB (Oxford) 2009;11:529–531.
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.
Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique. Transplantation 2003;76:803–807.
Takayama T, Tanaka T, Higaki T, Katou K, Teshima Y, Makuuchi M. High dorsal resection of the liver. J Am Coll Surg 1994;179:72–75.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nanashima, A., Tobinaga, S., Abo, T. et al. Left hepatectomy accompanied by a resection of the whole caudate lobe using the dorsally fixed liver-hanging maneuver. Surg Today 41, 453–458 (2011). https://doi.org/10.1007/s00595-010-4291-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-010-4291-3