Right hepatectomy using the liver double-hanging maneuver through the retrohepatic avascular tunnel on the right of the inferior vena cava

Abstract

The key to Belghiti's liver-hanging maneuver is to develop a retrohepatic tunnel. This procedure requires a blind dissection of the plane anterior to the inferior vena cava (IVC), with the inherent risks of damaging the short hepatic veins and consequential bleeding. The aim of this article is to describe a liver double-hanging maneuver with the advantage of being technically simple and safe. The operator uses his or her right index finger to dissect the space from below upward between the hepatic parenchyma and the anterior and superior edge of the right adrenal gland, which is situated just on the right side of the IVC. The operator then uses his left index finger to dissect the retrohepatic space from above downward on the right side of suprahepatic IVC, which is lateral to where the right hepatic vein joins the IVC. The retrohepatic tunnel is built when the 2 fingers touch each other. A kidney pedicle forceps is used to place 2 tapes around the liver for suspension. In all, 65 patients underwent right hepatectomy using this maneuver. The study included 62 patients with hepatocellular carcinoma (tumor size: mean +/- SD, 10 +/- 3.7 cm), and 3 patients had hepatic cavernous hemangioma, with a maximum diameter of 12.6 cm, 14.4 cm, and 22.6 cm, respectively. No major bleeding was encountered during the creation of the retrohepatic tunnel, with a success rate of 100%. To develop the retrohepatic tunnel in the space on the right of the IVC is absolutely bloodless, and it is technically easy and safe.