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Two step hanging maneuver

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Chapter 10

Two-Step Hanging Maneuver for an Isolated Resection
of the Dorsal Sector of the Liver
Hideaki Uchiyama, Shinji Itoh and Kenji Takenaka
Additional information is available at the end of the chapter


1. Introduction
Resection of malignant lesions arising in the dorsal sector of the liver is a challenging procedure
because the sector is located deep in the abdominal cavity and surrounded by the inferior vena
cava (IVC) and the major hepatic veins [1 – 9]. A hanging maneuver is an innovative procedure
in hepatic surgeries, in which the liver parenchyma is hung by a tape, thereby making a straight
cutting line [10 – 14]. This technique was applied in two patients who had a hepatocellular
carcinoma (HCC) in the dorsal sector. Patient 1 was a 46-year-old female, who was found to
have an HCC, approximately 3 cm in diameter, located just above the IVC. The patient had a
large inferior right hepatic vein (IRHV). The superior right hepatic vein (SRHV) and the IRHV
were individually controlled with a tape after dividing several short hepatic veins from the
right side of the IVC. A cotton tape was introduced from the groove between the SRHV and
the middle hepatic vein (MHV) to the right and left Glisson sheaths via the space just next to
the left side of the IRHV. The liver was split into the right and left hemilivers by pulling the
tape upwards. Next, the tape was introduced from the space behind the confluence of the MHV
and the left hepatic vein (LHV) to the space behind the left Glisson sheath via the fissure of
the ligamentum venosum after dividing a few small Glisson branches into the caudate lobe
from the left Glisson sheath. The liver parenchyma was divided between the medial sector and
the dorsal sector by pulling the tape medially, Finally, the dorsal sector including the tumor
was resected by dividing the short hepatic veins from the left side of the IVC. Patient 2 was a
59-year-old male, who was found to have an HCC, approximately 3 cm in diameter, located
in the Spiegel lobe (a part of the dorsal sector) during a follow-up for chronic hepatitis B. The
tumor compressed the left side of the IVC and protruded inferomedially. Cotton tape was
introduced from the groove between the MHV and the LHV to the groove between the right
and left Glisson sheaths via the posterior surface of the liver after dividing all the short hepatic

© 2013 Uchiyama et al.; licensee InTech. This is an open access article distributed under t...
Chapter 10
Two-Step Hanging Maneuver for an Isolated Resection
of the Dorsal Sector of the Liver
Hideaki Uchiyama, Shinji Itoh and Kenji Takenaka
Additional information is available at the end of the chapter
http://dx.doi.org/10.5772/51768
1. Introduction
Resection of malignant lesions arising in the dorsal sector of the liver is a challenging procedure
because the sector is located deep in the abdominal cavity and surrounded by the inferior vena
cava (IVC) and the major hepatic veins [1 9]. A hanging maneuver is an innovative procedure
in hepatic surgeries, in which the liver parenchyma is hung by a tape, thereby making a straight
cutting line [10 14]. This technique was applied in two patients who had a hepatocellular
carcinoma (HCC) in the dorsal sector. Patient 1 was a 46-year-old female, who was found to
have an HCC, approximately 3 cm in diameter, located just above the IVC. The patient had a
large inferior right hepatic vein (IRHV). The superior right hepatic vein (SRHV) and the IRHV
were individually controlled with a tape after dividing several short hepatic veins from the
right side of the IVC. A cotton tape was introduced from the groove between the SRHV and
the middle hepatic vein (MHV) to the right and left Glisson sheaths via the space just next to
the left side of the IRHV. The liver was split into the right and left hemilivers by pulling the
tape upwards. Next, the tape was introduced from the space behind the confluence of the MHV
and the left hepatic vein (LHV) to the space behind the left Glisson sheath via the fissure of
the ligamentum venosum after dividing a few small Glisson branches into the caudate lobe
from the left Glisson sheath. The liver parenchyma was divided between the medial sector and
the dorsal sector by pulling the tape medially, Finally, the dorsal sector including the tumor
was resected by dividing the short hepatic veins from the left side of the IVC. Patient 2 was a
59-year-old male, who was found to have an HCC, approximately 3 cm in diameter, located
in the Spiegel lobe (a part of the dorsal sector) during a follow-up for chronic hepatitis B. The
tumor compressed the left side of the IVC and protruded inferomedially. Cotton tape was
introduced from the groove between the MHV and the LHV to the groove between the right
and left Glisson sheaths via the posterior surface of the liver after dividing all the short hepatic
© 2013 Uchiyama et al.; licensee InTech. This is an open access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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