Various liver resections using hanging maneuver by three Glisson's pedicles and three hepatic veins

Objective: To introduce a simple and effective technique for various kinds of anatomic liver resection using the hanging maneuver by 3 Glisson's pedicles and 3 hepatic veins. Summary Background Data: The advantages of the liver-hanging maneuver described by Belghiti et al and the anatomic characteristics peculiar to the liver induced us to devise another new approach to the use of a hanging technique applied to various kinds of anatomic liver resection. Methods: The hanging tape is located along the anteromedian surface of the retrohepatic IVC or the ligamentum venosum with its upper end among 3 hepatic veins and with its lower end among 3 Glisson's pedicles. With both ends of the tape pulled up, the hepatic parenchymal transection is performed aiming at the tape. Results: From March 2003 to October 2005, this technique was used in 187 anatomic liver resections. Three (1.6%) of the patients required blood transfusion during or after surgery. There was no operative mortality or major morbidity and no reoperation. Conclusions: This technique has the advantages of hanging maneuver based on the anatomic considerations of the liver and needs minimal mobilization of the remaining liver. The hanging maneuver can be a key technique for anatomic liver resection.