Abstract
IntroductionThe liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, however it is often difficult in laparoscopic major hepatectomy. The present study describes a novel modified hanging maneuver in laparoscopic left hemihepatectomy. Presentation of caseA 29-year-old female underwent laparoscopic left hemihepatectomy for mucinous cystic neoplasm. After mobilizing the left lobe, the liver parenchyma was dissected along the demarcation line. For the hanging technique, the upper edge of the hanging tape was placed on the lateral side of the left hepatic vein, and fixed with the Falciform ligament. The lower edge of the tape was extracted outside the abdomen. Accordingly the hanging tape can be controlled extraperitoneally during the liver parenchyma dissection. DiscussionThis technique includes several advantages including no need of assistance using forceps, easy control of the hanging tape extraperitoneally, outflow control, better exposure of surgical field, and helpful guide of the liver dissection line toward the root of the left hepatic vein. ConclusionOur novel modified hanging maneuver is easy and reproducible to use in laparoscopic left hemihepatectomy. Moreover, this technique can be applied to other laparoscopic hepatectomy.
Highlights
The liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, it is often difficult in laparoscopic major hepatectomy
The liver hanging maneuver is a helpful technique for outflow control mostly used in open hepatectomy, few studies have reported on use of hanging maneuver in laparoscopic left hemihepatectomy [3]
A modified liver hanging maneuver, which does not require the dissection of the left hepatic vein (LHV) with the upper end of the hanging tape placed on the lateral side of the LHV, has been reported in laparoscopic left hemihepatectomy [4]
Summary
The liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, it is often difficult in laparoscopic major hepatectomy. The present study describes a novel modified hanging maneuver in laparoscopic left hemihepatectomy. The upper edge of the hanging tape was placed on the lateral side of the left hepatic vein, and fixed with the Falciform ligament. The hanging tape can be controlled extraperitoneally during the liver parenchyma dissection. DISCUSSION: This technique includes several advantages including no need of assistance using forceps, easy control of the hanging tape extraperitoneally, outflow control, better exposure of surgical field, and helpful guide of the liver dissection line toward the root of the left hepatic vein. CONCLUSION: Our novel modified hanging maneuver is easy and reproducible to use in laparoscopic left hemihepatectomy. This technique can be applied to other laparoscopic hepatectomy
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