Straightforward Anterior Hepatic Transection During Left Hepatectomy and Caudate Lobe Resection for Hilar Bile Duct Cancer

Abstract

Introduction: The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, but it has several technical limitations for resection of the hepatic paracaval portion. We had presented a modified LHM that facilitates concurrent resection of the paracaval portion, a technique applicable to left liver resection for hilar bile duct (HBD) cancers. However, after accumulation of experience, straightforward anterior resection appeared more feasible without using any type of LHM Methods: During 2010 and 2011, 10 HBD cancer patients underwent left liver resection, with intentional omission of LHM. This method included straightforward anterior transection to the caudal paracaval portion. The parenchyma transection plane was tailored to remove most of the paracaval portion Results: In this revised technique, liver transection was totally approached from the right side, with no touch to the left side. After parenchymal transection, the left liver was mobilized and removed. This modification resulted in shortening of operation time by 30 minutes and omission of painstaking retrohepatic tunneling. The final parenchymal transection plane was the same as that following conventional surgical technique for HBD cancers. Conclusion: In conclusion, we think that this straightforward anterior transection method is as effective as using modified LHM and technically simpler procedure for resection of the left liver and caudate lobe in HBD patients.