Liver hanging maneuver: an anatomic and clinical review

• Published in: The American journal of surgery Vol. 193; no. 4; pp. 488 - 492
• Main Authors: Gaujoux, Sébastien, M.D, Douard, Richard, M.D, Ettorre, Giuseppe Maria, M.D, Delmas, Vincent, M.D., Ph.D, Chevallier, Jean-Marc, M.D., Ph.D, Cugnenc, Paul-Henri, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2007; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Dissection; General aspects; Hepatectomy; Hepatectomy - methods; Hepatic Veins - injuries; Humans; Liver; Liver - anatomy & histology; Liver - blood supply; Liver - surgery; Liver anatomy; Liver hanging maneuver; Liver, biliary tract, pancreas, portal circulation, spleen; Mandibular Nerve; Medical sciences; Retro hepatic inferior vena cava; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Veins & arteries; Liver hanging maneuver; Liver anatomy; Retro hepatic inferior vena cava; Hepatectomy; Liver; Review; Anatomy; Medicine; Treatment; Hanging; Surgery; Bibliographic review; Inferior vena cava
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2006.04.006

Abstract Background Liver hanging maneuver (LHM) allows to hang the liver during right hepatectomies without primary liver mobilization. The avascular plane used in this technique has been poorly described in the anatomical literature, and intraoperative bleeding because of hepatic vein injuries has been reported. Data Sources Major clinical and anatomic articles focusing on the retrohepatic portion of the inferior vena cava (IVC) and the LHM were reviewed. Conclusions LHM is as an effective and safe method of guiding hepatic transection to the IVC during right hepatectomies with a feasibility rate up to 95% and minor bleeding in 0% to 6% of cases. According to small series and experts’ opinions, LHM would improve parenchymal transection by reducing operative time and blood loss. The tape would ensure a linearly cut surface with IVC safer protection, better exposure, and hemostasis of the deeper plane. Limited remnant liver mobilization could reduce the risk for malignant dissemination and improve liver function. Hepatectomies for huge tumor with diaphragm adhesions could be facilitated.