Anatomical justification of Belghiti's ‘liver hanging manoeuvre’ in right hepatectomy with anterior approach

Meng, Weiliang; Shao, Chuxiao; Mak, Kong Ling; Lau, Patrick S. Y.; Yeung, Y; Yip, A. W. C.

doi:10.1046/j.1445-2197.2003.t01-1-02633.x

Cited by 25 publications

(34 citation statements)

References 3 publications

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“…The avascular ''tunnel'' contains, on average, 3.7 SHVs which are relatively small (between 0.2 and 0.3 cm in diameter). Compared to other authors' reports [10][11][12][13], the number of SHVs in our group was smaller. Still, a special attention must be paid to the dissection of retrohepatic space; specifically, if the surgeon's assistant ignorantly rotates the right liver and tears SHVs or if the surgeon accidentally pierces RHICV, copious bleeding or air embolism will spontaneously occur.…”

Section: Discussioncontrasting

confidence: 78%

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

Qin

Wang

et al. 2011

Cell Biochem Biophys

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We wished to study the efficacy and safety of the retrograde ligation of short hepatic veins (SHVs) and the right hepatic vein (HV) through the retrohepatic tunnel in patients who underwent hemihepatectomy due to large hepatic carcinoma in the right lobe of the liver. Right hemihepatectomy was performed in 23 patients with tumors larger than 8 cm in diameter. The liver was separated at the secondary porta, and the interspace between right HVs and middle HVs was expanded. The right hepatic portal vein and hepatic artery were freed and ligated, followed by the retrograde dissection of SHVs and the right HV along the right retrohepatic space anterior to the inferior vena cava. A blocking belt was set at the left side of the midline, after which the right liver was cut off. The procedure was successfully completed in all patients. The average amount of intraoperative blood loss was 640 ml. The change in hepatic function was observed on the third postoperative day. Twenty-two patients exhibited satisfactory results; one patient died from postoperative hepatic failure. In conclusion, this procedure can be safely performed in most hemihepatectomy patients with liver tumors.

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Section: Discussioncontrasting

confidence: 78%

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

Qin

Wang

et al. 2011

Cell Biochem Biophys

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“…The IVC phase was timed in order to enable a stenotic IVC to fill with contrast medium. [13] Images were formatted in the axial, sagittal, and coronal planes. MRI with a dynamic enhanced angiography sequence was performed on a 1.5 Tesla or 3.0 Tesla Signa (HDxt 3.0T, General Electronic, USA).…”

Section: Methodsmentioning

confidence: 99%

Initial Imaging Analysis of Budd-Chiari Syndrome in Henan Province of China: Most Cases Have Combined Inferior Vena Cava and Hepatic Veins Involvement

et al. 2014

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AimTo evaluate the type of venous involvement in Chinese Budd-Chiari syndrome (BCS) patients and the relative diagnostic accuracy of the different imaging modalities.MethodsUsing digital subtraction angiography (DSA) as a reference standard, color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) were performed on 338 patients with BCS. We analyzed the course of the main and any accessory hepatic veins (HVs) and the inferior vena cava (IVC) to assess the etiology of obstructed segments and diagnostic accuracy of CDUS, CTA and MRA.ResultsAmong the 338 cases, there were 8 cases (2.4%) of isolated IVC membranous obstruction, 45 cases (13.3%) of isolated HV occlusion, and 285 cases (84.3%) with both IVC membranous obstruction and HV occlusion. Comparing with DSA, CDUS, CTA had a diagnostic accuracy of 89.3% and 80.2% in detecting BCS, and 83.4% of cases correctly correlated by MRA.ConclusionIn Henan Province, most patients with BCS have complex lesions combining IVC and HV involvement. The combination of CDUS and CTA or MRI is useful for diagnosis of BCS and guiding therapy.

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“…However, right hepatectomy can be performed safely by combining the hanging maneuver with an anterior approach. 4 A straight-down transection along the principal plane between the right and left lobes provides the smallest Meng et al 3 suggested that the surgeon visualize the tunnel by pointing the laparoscope cranially from the infrahepatic region. However, we found that the abdominal wound limits the application of a rigid straight laparoscope, making handling in the narrow tunnel awkward.…”

Section: Discussionmentioning

confidence: 99%

Safe Modification of the Liver-Hanging Maneuver by Endoscopic-Assisted Dissection of the Retrohepatic Tunnel

Lai

Wong

et al. 2007

Surg Today

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As a safer approach to right hepatectomy, Belghiti et al. (J Am Coll Surg 193:109-11, 2001) described a liver-hanging maneuver. However, this procedure is performed blind, with the risks of damaging the small retrohepatic veins and consequential bleeding. To overcome this problem, we modified the procedure so that, instead of performing blind dissection using a long vascular clamp, we use a flexible choledochoscope to dissect the retrohepatic space filled by loose alveolar tissue anterior to the inferior vena cava (IVC). The avascular path is identified by a combination of saline irrigation and gentle movement of the tip of the choledochoscope. Cotton tape can then be passed around the liver parenchyma to elevate the liver away from the anterior surface of the IVC. This modification of Belghiti's liver-hanging maneuver allows direct vision along the plane anterior to the IVC, thus avoiding injury to the retrohepatic veins.

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Anatomical justification of Belghiti's ‘liver hanging manoeuvre’ in right hepatectomy with anterior approach

Cited by 25 publications

References 3 publications

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

Initial Imaging Analysis of Budd-Chiari Syndrome in Henan Province of China: Most Cases Have Combined Inferior Vena Cava and Hepatic Veins Involvement

Safe Modification of the Liver-Hanging Maneuver by Endoscopic-Assisted Dissection of the Retrohepatic Tunnel

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