Blocking intrahepatic inflow and backflow using Chang's needle during hepatic resection: Chang's maneuver.

Area of Science:

• Hepatobiliary Surgery
• Surgical Instrumentation
• Vascular Surgery

Background:

• Chang's needle, introduced in 1996, is a specialized surgical tool for hepatic resections.
• It is a straight, 18-gauge stainless steel needle with a hook designed for secure suturing.
• Prior experience indicates its use in hepatic resections is both simple and safe.

Purpose of the Study:

• To explore a novel application of Chang's needle for intrahepatic vascular blocks during liver resections.
• To evaluate the safety and efficacy of using Chang's needle for inflow and backflow control.
• To assess the impact on blood loss and ischemia-reperfusion injury.

Main Methods:

• Chang's needle facilitates whole-thickness interlocking sutures for liver parenchyma division.
• Multiple sutures secure inflow and backflow, enabling controlled hepatic parenchymal division with reduced blood loss.
• Ultrasound guidance allows temporary suturing of Glisson sheath branches for inflow control and hepatic veins for backflow control.

Main Results:

• Eighty-nine hepatic resections were performed, including various types like right lobectomies and segmentectomies, with no procedure-related mortality or hepatic failure.
• Twenty-seven patients had mild to severe liver cirrhosis, demonstrating the technique's applicability in complex cases.
• Minimal liver function deterioration was observed in patients undergoing temporary vascular blocks, highlighting reduced ischemia-reperfusion injury.

Conclusions:

• Chang's maneuver is effective for individual intrahepatic inflow or backflow blocks, or both, during hepatic resections.
• This technique minimizes ischemic and reperfusion injuries, improving patient outcomes.
• The application extends beyond standard hepatic resections, offering versatility in liver surgery.