Anatomical Basis of Liver Hanging Maneuver: A Clinical and Anatomical in Vivo Study

2007 ◽  
Vol 73 (11) ◽  
pp. 1193-1196 ◽  
Author(s):  
Giuseppe Maria Ettorre ◽  
Richard Douard ◽  
Valerio Corazza ◽  
Roberto Santoro ◽  
Giovanni Vennarecci ◽  
...  
Keyword(s):  
Vena Cava ◽  
Small Diameter ◽  
Hepatic Veins ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Liver Hanging Maneuver ◽  
Anatomical Basis ◽  
Hanging Maneuver ◽  
Large N ◽  
Small N

Liver Hanging Maneuver (LHM) provides better exposure of the deeper section plane together with Inferior Vena Cava (IVC) protection during right hepatectomies without primary liver mobilization. This study assessed the feasibility and complication rates of LHM focusing on the anatomical distribution of the accessory hepatic veins in the retrohepatic portion of the IVC. From January 2002 to December 2005, LHM was planned in 49 consecutive major hepatectomies. The IVC retrohepatic portion was studied during the anhepatic phase in 17 liver transplantations with IVC preservation. The diameter and location of the vein openings were recorded after IVC division into nine portions. LHM was achieved in 47/49 patients (96%). Bleeding occurred in only one patient (2%) and did not entail procedure interruption. The anatomical study revealed a total of 86 veins present in 17 cases (5.18 ± 4 per patient) and classified them according to diameter (<3, 3 to 6, and >6 mm), as small (n = 40), medium (n = 29), and large (n = 17), respectively. Nine openings were found in the avascular channel for 6/17 (35%) patients (small n = 6, medium n = 3, large n = 0). LHM is a highly feasible procedure with minor bleeding risks due to the lower density and small diameter of short hepatic veins and caudate veins present in the avascular channel.

scholarly journals Efficacy of Transhepatic Anterior Approach to the Inferior Vena Cava for Malignant Pheochromocytoma Invading Right Posterior Lobe of the Liver: A Case Report

2019 ◽  
Vol 103 (1-2) ◽  
pp. 80-86
Author(s):  
Gen Tsujio ◽  
Kenjiro Kimura ◽  
Yukie Tauchi ◽  
Go Ohira ◽  
Ryosuke Amano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Anterior Approach ◽  
Inferior Vena ◽  
Vena Cava ◽  
Right Hepatectomy ◽  
Liver Hanging Maneuver ◽  
Hanging Maneuver ◽  
Right Lobe ◽  
The Right

Introduction: The anterior approach to the inferior vena cava (IVC) by the liver hanging maneuver is effective in resecting large retrohepatic tumors without mobilizing the right lobe. Case presentation: A 50-year-old man was referred to our hospital with a diagnosis of pheochromocytoma. He had severe congestive heart failure and cardiac ejection fraction was 15%. Abdominal magnetic resonance imaging (MRI) and ultrasonography (US) showed an adrenal mass about 80 mm in diameter. The tumor-infiltrated posterior segment of the right hepatic lobe and tumor were widely attached to the IVC. After treatment of congestive heart failure with conservative therapy, surgery was planned. Right adrenectomy and right hepatectomy were performed, the latter using the liver hanging maneuver to avoid mobilizing the right lobe, and we were able to minimize blood pressure fluctuations and perform the operation safely. The histopathologic diagnosis was malignant pheochromocytoma. Conclusions: We performed right hepatectomy without mobilizing the right lobe by the liver hanging maneuver and minimized stimulation of the tumor. We could perform the operation safely using the liver hanging maneuver, which seems effective in such cases.

scholarly journals Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yue Hu ◽  
Jiong Shi ◽  
Shaohe Wang ◽  
Wenjie Zhang ◽  
Xitai Sun ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Liver Diseases ◽  
Vena Cava ◽  
Operation Time ◽  
Hepatic Veins ◽  
The Novel ◽  
Hanging Maneuver ◽  
Glissonean Pedicle ◽  
Hematoxylin And Eosin ◽  
Hospital Days

Abstract Background Although isolating Glissonean pedicles and hepatic veins are critical procedures during anatomical hepatectomy, there is no standardized approach. We propose the novel Laennec’s approach for laparoscopic anatomic hepatectomy (LAH) based on Laennec’s capsule, which serves as the anatomic landmark for LAH. The aim of this study was to elucidate that the natural gap between Laennec’s capsule and the adjacent tissues contributes to standardization of the surgical technique for LAH. Methods Eighty-four cases were enrolled in this observable clinical trial. They underwent LAH for liver diseases. Laennec’s approach was proposed for LAH based on Laennec’s capsule. The liver tissues close to Glissonean pedicle, hepatic veins, naked area, and inferior vena cava were collected for hematoxylin and eosin, resorcinol-fuchsin staining, and immunohistochemistry. Results The staining revealed capsule packaging of the whole liver independent of the adjacent tissues and intrahepatic vessels. A natural gap was found between Laennec’s capsule and the adjacent tissues at different sites. Laennec’s capsule served as the landmark for isolating Glissonean pedicle and hepatic veins, mobilizing the liver, and performing Hanging maneuver. Eighty-four cases underwent LAH for liver diseases using this strategy. The operation time was 277.23 min. The mean of hospital days was 9.8. Conclusions Laennec’s approach based on Laennec’s capsule contributes to standardization of the surgical technique for LAH, and brings innovations that facilitates safe and effective liver resection under laparoscopy.

scholarly journals Liver Hanging Maneuver: importante técnica cirúrgica nas grandes ressecções hepáticas / Liver Hanging Maneuver: important surgical technique in the large liver resections

2019 ◽  
Vol 64 (2) ◽  
pp. 164
Author(s):  
Lucas Fiori Ribas ◽  
Raíssa Franco Godoy de Castro ◽  
Willian Andrade Silva ◽  
Mauricio Alves Ribeiro ◽  
Andrea Zaidan de Almeida Barros ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Vena Cava ◽  
Hepatic Tumor ◽  
Liver Hanging Maneuver ◽  
Liver Remnant ◽  
Liver Resections ◽  
Hanging Maneuver ◽  
Safe Technique ◽  
Resectability Criteria

Introdução/Objetivos: O Colangiocarcinoma é o segundo tumor hepático maligno mais prevalente, apresentando prognóstico reservado quando não é passível de ressecção, já que esta é sua única possibilidade de cura. Visando melhores resultados na terapêutica cirúrgica, além de critérios adequados de ressecabilidade, é impreterível a técnica cirúrgica mais segura e eficaz. Atualmente, observa-se que o uso da Liver Hanging Maneuver (LHM), como componente da técnica de abordagem anterior (AA) das grandes ressecções hepáticas, tem conferido a essas, maior viabilidade, já que permite: menor hemorragia; menor manipulação e ruptura tumoral; maior estabilidade na manipulação da Veia Cava Inferior (VCI); reduzido dano isquêmico ao fígado remanescente e melhor sobrevivência aos pacientes com tumor hepático. Relato de Caso: Paciente do sexo feminino, 58 anos submetida a uma trisetorectomia com abordagem anterior e uso da Liver Hanging Maneuver devido a um colangiocarcinoma intrahepático. Resultados: Boa evolução pós-operatória e atualmente está com dois anos de seguimento ambulatorial. Apresentamos os aspectos técnicos da “Liver Hanging Maneuver”. Conclusão: Técnica segura que aumenta a viabilidade das grandes ressecções hepáticas, principalmente nos casos de tumores intra-hepáticos grandes, como no caso discutido nesse relato.Descritores: Neoplasias hepáticas, Colangiocarcinoma, Carcinoma hepatocelular, Ductos biliares intra-hepáticos; Hepatectomia/métodos AbstractIntroduction/Purpose: Cholangiocarcinoma is the second most prevalent hepatic tumor presenting a reserved prognosis when is not amenable to resection, because this treatment is the only possibility of cure. Seeking for better surgical outcomes, beyond of adequate resectability criteria, the safety and most effective surgical technique is fundamental. Nowadays, it is observed that the use of Liver Hanging Maneuver as a component of the anterior approach techinique of large liver resections has conferred to these greater viability, since it allows: less haemorrhage; less tumoral manipulation and rupture; better haemodynamic stability by avoiding any twisting of the inferior vena cava; reduced ischemic damage of the liver remnant, and better survival for patients with hepatic tumor. Case report: 58-year-old patient, female, did submit to a trisetorectomy due to intrahepatic cholangiocarcioma with the use of the Liver Hanging maneuver. Results: Good postoperative evolution and currently has two years follow-up. We introduce the technical aspects of Liver Hanging Maneuver. Conclusion: A safe technique that increases the viability of large hepatic resections, especially in cases of large intrahepatic tumors, as in the case discussed in this report.Keywords: Liver neoplasms; Cholangiocarcinoma; Carcinoma, hepatocellular; Bile ducts, intrahepatic; Hepatectomy/methods

A hanging manőver újabb indikációi a májsebészetben

2012 ◽  
Vol 65 (6) ◽  
pp. 407-415
Author(s):  
Ferenc Jakab ◽  
Kristóf Dede ◽  
István Láng ◽  
Attila Bursics ◽  
Tamás Mersich
Keyword(s):  
Vena Cava ◽  
Vena Cava Inferior ◽  
Liver Hanging Maneuver ◽  
Hanging Maneuver

Absztrakt A „hanging maneuver” (LHM – Liver Hanging Maneuver) emelőszalag átvezetését jelenti a vena cava inferior és a májparenchyma között a resectio megkönnyítésére. A szerzők áttekintik a „hanging maneuver” májsebészeti alkalmazását, különböző módosításait, anatómiai és szövettani alapjait. Megállapítják, hogy a módszer a májsebészet biztonságának fokozására és a radikalitás növelése érdekében alakult ki. Kezdetben a jobb májfél nagy kiterjedésű, rekesszel összekapaszkodott daganatainak eltávolításához használták, később számos új indikációja és módosítása született. A szerzők két újabb indikációt dolgoztak ki a „hanging maneuver” alkalmazására. A IVA szegmentumban elhelyezkedő colorectalis májmetastasis, illetve a HCC resecabilitásának műtéti megállapítására és vérmentes resectiójához használták. A VII. szegmentumban lévő vena cava inferiort infiltráló daganat esetében pedig a hanging maneuver a partialis cavaresectiót könnyítette meg. A szerzők 4 esetüket mutatják be röviden. Megállapítható, hogy az LHM részint a IVA, VII. szegmentum resectiójának kivitelezhetőségét, részint biztonságát fokozza. A képalkotó eljárások utalhatnak a vena cava inferiorhoz közel fekvő daganatra, de a fali infiltratiót kizárólag intraoperatíve lehet teljes biztonsággal megállapítani. A vascularis infiltratio igazolására vagy kizárására az intraoperatív ultrahang és a jelenlegi előadásban javasolt LHM alkalmazható.

Modified liver hanging maneuver during orthotopic liver transplantation with inferior vena cava preservation

2003 ◽  
Vol 75 (2) ◽  
pp. 247-249 ◽  
Author(s):  
Giuseppe Maria Ettorre ◽  
Giovanni Vennarecci ◽  
Roberto Santoro ◽  
Mario Antonini ◽  
Maria Teresa Lonardo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Orthotopic Liver Transplantation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Liver Hanging Maneuver ◽  
Hanging Maneuver

scholarly journals Safe Resection of Renal Cell Carcinoma with Liver Invasion Using Liver Hanging Technique Supported by Preoperative Portal Vein Embolization

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Masato Fujii ◽  
Toshio Kamimura ◽  
Hiromasa Tsukino ◽  
Eiji Furukoji ◽  
Tatefumi Sakae ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Portal Vein ◽  
Cell Carcinoma ◽  
Portal Vein Embolization ◽  
Renal Cell ◽  
Liver Volume ◽  
Vena Cava ◽  
Parenchymal Transection ◽  
Liver Hanging Maneuver ◽  
Hanging Maneuver

In cases of RCC with liver involvement, partial hepatectomy is known to provide a better chance of survival for patients. For this reason, complete resection with clear surgical margin is thought to be necessary to achieve favorable outcome. Anterior liver hanging maneuver was extremely useful during hemihepatectomy in this rare type of RCC. A 63-year-old male was diagnosed with a large right renal cell carcinoma. The tumor measured 10 cm in diameter with tumor thrombus toward the inferior vena cava (IVC). In addition, we observed direct infiltration to the liver. We attempted a preoperative portal vein embolization (PVE) to preserve residual liver volume and function after right lobectomy. After PVE the resected volume decreased from 921 cm3(71%) to 599 cm3(53.4%). During the procedure, a nasogastric tube was placed in the retrohepatic space for liver hanging maneuver according to the original Belghiti’s maneuver after dissection of the renal artery and vein. After hepatic parenchymal transection exposing vena cava, the right hepatic veins were safely transected using vascular stapler; right nephrectomy and hemihepatectomy were performed. The patient recovered without postoperative hepatic or urinary complications and has remained free of local recurrence and any de novo metastasis for 18 months.

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