Double liver hanging manoeuvre for central hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Transplantation

Background:

• Central hepatectomy is challenging due to proximity to major vascular structures.
• Liver hanging manoeuvre (LHM) offers improved exposure for complex liver resections.
• Tumors compressing hilar vessels and hepatic veins require specialized resection techniques.

Purpose of the Study:

• To describe a modified liver hanging manoeuvre (LHM) for anatomic central hepatectomy.
• To evaluate the safety and efficacy of the modified LHM for large, centrally located liver tumors.
• To demonstrate the utility of the technique in resecting a hepatocellular carcinoma compressing hilar vessels.

Main Methods:

• Modification of the standard Belghiti's liver hanging manoeuvre (LHM).
• Placement of two small tubes within the cut planes: one between left lateral and medial sections, and another along the right hepatic vein.
• Performance of complete anatomic central hepatectomy for a large tumor.

Main Results:

• The modified LHM facilitated easy and safe resection of a large central hepatocellular carcinoma.
• The technique provided adequate exposure and control of hilar vessels and the right hepatic vein.
• Successful tumor removal was achieved in a 57-year-old male patient.

Conclusions:

• The modified liver hanging manoeuvre (LHM) is a valuable modification for achieving complete anatomic central hepatectomy.
• This technique enhances safety and ease of resection for complex liver tumors, particularly those involving major vascular compression.
• The described approach offers a promising solution for challenging liver tumor resections.