Left hepatectomy accompanied by a resection of the whole caudate lobe using the dorsally fixed liver-hanging maneuver

Abstract

Abstract.Resection of the caudate lobe needs to be combined with hemi-hepatectomy for hilar cholangiocarcinoma or liver tumor in segment 1. To achieve complete resection of the whole caudate lobe, the cut-line between the right edge of paracaval portion and right lateral sector should be controlled. The liver-hanging maneuver (LHM) is useful for anterior approach without mobilization of the remnant liver. The precise set up of cut-line of the right edge was not indicated by previous reports yet. We herein introduce a new modification of LHM named "dorsally fixed liver-hanging maneuver" (DF-LHM) by the results in 5 patients who underwent left hepatectomy combined total resection of segment 1. This technique provided adequate cut planes along the right edge of the caudate lobe, shortening the transection time and reducing intraoperative blood loss. DF-LHM can be a key technique for this hepatectomy and further applications to other anatomical resections can be expected.

Significance of liver hanging maneuver for anatomical hepatectomy in patients with a large hepatocellular carcinoma compressing intrahepatic vasculatures

“…It was then passed easily through the dissecting space. 15 We completed tube insertion within approximately 20 min. After the insertion, the tube was lifted for LHM.…”

Anatomy of the retrohepatic tunnel in a Chinese population and its clinical application in liver surgery

“…Thus, the surgical approach should be selected based on the surgeon’s preference9. “Caudate lobe fixation” LHM10 for hilar cholangiocarcinoma can also be replaced with the traditional method. In actual practice, the LHM is often used in difficult cases, for instance, cases involving a large tumor or a caudate lobe tumor11.…”

Liver parenchyma transection‐first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes

“…In major hepatic resection combined with whole caudate lobectomy utilizing the anterior approach, there have been two critical points as follows: (i) setting the direction of the parenchymal transection plane for whole caudate lobe resection; and (ii) controlling bleeding in the deep area of transection around the caudate lobe. To solve these problems, several modified LHM techniques have been proposed for the surgical management of hilar cholangiocarcinoma that have contributed to reduced blood loss and to complete safety during a total caudate lobectomy . However, in all previous reports, these reported LHM techniques have been employed after mobilization of the future liver remnant or resection of the diseased liver .…”

“…To solve these problems, several modified LHM techniques have been proposed for the surgical management of hilar cholangiocarcinoma that have contributed to reduced blood loss 21,22 and to complete safety during a total caudate lobectomy. [21][22][23][24] However, in all previous reports, these reported LHM techniques have been employed after mobilization of the future liver remnant or resection of the diseased liver. [21][22][23][24] In addition, this situation that uses liver mobilization during hemihepatectomy is unfavorable in terms of preventing cholangiovenous reflex-related bacterial dissemination.…”

“…[21][22][23][24] However, in all previous reports, these reported LHM techniques have been employed after mobilization of the future liver remnant or resection of the diseased liver. [21][22][23][24] In addition, this situation that uses liver mobilization during hemihepatectomy is unfavorable in terms of preventing cholangiovenous reflex-related bacterial dissemination. 12 Therefore, we devised a safer approach that may solve these problems altogether.…”