Various Liver Resections Using Hanging Maneuver by Three Glisson??s Pedicles and Three Hepatic Veins

In Brief Objective: To introduce a simple and effective technique for various kinds of anatomic liver resection using the hanging maneuver by 3 Glisson's pedicles and 3 hepatic veins. Summary Background Data: The advantages of the liver-hanging maneuver described by Belghiti et al and the anatomic characteristics peculiar to the liver induced us to devise another new approach to the use of a hanging technique applied to various kinds of anatomic liver resection. Methods: The hanging tape is located along the anteromedian surface of the retrohepatic IVC or the ligamentum venosum with its upper end among 3 hepatic veins and with its lower end among 3 Glisson's pedicles. With both ends of the tape pulled up, the hepatic parenchymal transection is performed aiming at the tape. Results: From March 2003 to October 2005, this technique was used in 187 anatomic liver resections. Three (1.6%) of the patients required blood transfusion during or after surgery. There was no operative mortality or major morbidity and no reoperation. Conclusions: This technique has the advantages of hanging maneuver based on the anatomic considerations of the liver and needs minimal mobilization of the remaining liver. The hanging maneuver can be a key technique for anatomic liver resection. Considering the advantages of the liver-hanging maneuver and the anatomic characteristics peculiar to the liver, various kinds of anatomic liver resection can be performed by positioning the hanging tape along the anteromedian surface of the retrohepatic IVC or the ligamentum venosum with its upper end among 3 hepatic veins and with its lower end among 3 Glisson's pedicles.