Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2010 Aug;79(2):122-129. Korean.
    Published online Aug 02, 2010.
    https://doi.org/10.4174/jkss.2010.79.2.122
    Copyright © 2010 The Korean Surgical Society
    Original Article

    Clinical Application of Hepatic Resection Using Glissonean Pedicle Transection Method and Hanging Maneuver

    Kwan Woo Kim, M.D., Jeong-ik Park, M.D., Kwang-Min Park, M.D.,1 and Young-Joo Lee, M.D.1
      • Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
      • 1Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    • Corresponding author (Email: yjlee@amc.seoul.kr )
    Received March 10, 2010; Accepted April 06, 2010.

    Abstract

    Purpose

    The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, which is one of the most important innovations in the field of major hepatic resections. This study was conducted to review tumors' profiles after applying this procedure and to evaluate the usefulness of LHM and Glissonean pedicle transaction method (GPTM).

    Methods

    Medical records of 64 patients who underwent hepatic resection using LHM and GPTM at the Asan Medical Center were reviewed. The classic LHM was conducted according to the Belghiti method.

    Results

    Among 64 patients, 46 patients had hepatocellular carcinoma; 7, intrahpatic cholangiocarcinoma; 4, hilar cholangiocarcinoma; 4, metastatic liver cancer; 3, benign liver tumor. Mean tumor size was 10.6 cm (3~22). Mean liver parenchymal transection time was 20 min (15~30). Right side hepatectomy was performed in 44 patients; left side hepatectomy with or without caudate lobe was performed in 19 patients. Twenty patients (31.3%) required blood transfusion during surgery. There was no in-hospital mortality or major complications. Minor complications developed in 6 patients (9.37%).

    Conclusion

    GPTM and LHM are a safe and useful surgical application of various anatomical resections for huge liver tumor and an effective procedure during left hepatectomy with or without caudate lobe.

    Keywords
    Glissonean pedicle transaction method; Liver hanging maneuver; Anatomical liver resection; Left hepatectomy

    Figures

    Fig. 1
    Various hepatectomy using hanging maneuver clearly increased according to year, especially left side hepatectomy. Rt = right side hepatectomy; Lt = left side hepatectomy.

    Fig. 2
    (A) CT finding of a large hemangioma occupying central and left liver. The red line indicates transection plane of left trisegmentectomy. (B) CT finding of a large hepatocellular carcinoma occupying right posterior segment. The red line indicates transection plane of right posterior segmentectomy with middle hepatic vein. (C) CT finding of a large hepatocellular carcinoma occupying right liver. The red line indicates transection plane of right trisegmentectomy. (D) CT finding of a large hepatocellular carcinoma occupying left liver. The red bidirectional arrow indicates transection plane of left lobectomy+caudate lobe with Middle hepatic vein. The black unidirectional arrow indicates transaction plane of left loectomy with middle hepatic vein.

    Fig. 3
    Various direction of hanging tape during various hepatectomy. (A) The 'a' tape was used during right lobectomy or left lobectomy+caudate lobe with middle hepatic vein. The 'b' tape was used during right posterior segmentectomy with middle hepatic vein or left trisegmentectomy. The 'c' tape was used during right trisegmentectomy. (B) Direction of hanging tape during left lobectomy with middle hepatic vein or right hepatectomy with caudate lobe.

    Tables

    Table 1
    Clinicopathologic features of patients with malignant liver tumors

    Table 2
    Types of hepatectomy using hanging maneuver

    References

      1. Yamamoto M, Takasaki K, Ohtsubo T, Katsuragawa H, Fukuda C, Katagiri S. Effectiveness of systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery 2001;130:443–448.
      1. Torzilli G, Leoni P, Gendarini A, Calliada F, Olivari N, Makuuchi M. Ultrasound-guided liver resections for hepatocellular carcinoma. Hepatogastroenterology 2002;49:21–27.
      1. Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 1998;5:286–291.
      1. Takasaki K. Hepatic resection using glissonean pedicle transection. Nippon Geka Gakkai Zasshi 1998;99:245–250.
      1. Lai EC, Fan ST, Lo CM, Chu KM, Liu CL. Anterior approach for difficult major right hepatectomy. World J Surg 1996;20:314–318.
      1. Liu CL, Fan ST, Cheung ST, Lo CM, Ng IO, Wong J. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg 2006;244:194–203.
      1. Liu CL, Fan ST, Lo CM, Tung-Ping Poon R, Wong J. Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg 2000;232:25–31.
      1. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001;193:109–111.
      1. Hwang S, Lee SG, Lee YJ, Kim KH, Ahn CS, Kim KW, et al. Modified liver hanging maneuver to facilitate left hepatectomy and caudate lobe resection for hilar bile duct cancer. J Gastrointest Surg 2008;12:1288–1292.
      1. Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Kim CM. Isolated caudate lobectomy using the hanging maneuver. Surgery 2006;139:847–850.
      1. Suh KS, Lee HJ, Kim SH, Kim SB, Lee KU. Hanging maneuver in left hepatectomy. Hepatogastroenterology 2004;51:1464–1466.
      1. Tanaka S, Taira K, Kudo A, Nakamura N, Ito K, Arii S. Anterior approach for left-sided hepatic resection. Hepatogastroenterology 2008;55:1760–1763.
      1. Nanashima A, Sumida Y, Abo T, Takeshita H, Hidaka S, Sawai T, et al. Trisectionectomy for large hepatocellular carcinoma using the liver hanging maneuver. Eur J Surg Oncol 2009;35:326–330.
      1. Hwang S, Lee SG, Ha TY, Ahn CS, Park KM, Kim KH, et al. Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe. Liver Transpl 2004;10:1398–1405.
      1. Takatsuki M, Kawashita Y, Eguchi S, Tajima Y, Kanematsu T. Tape-guided living donor left hepatectomy. Am J Surg 2007;194:107–109.
      1. Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J. The liver hanging manoeuvre. HPB (Oxford) 2009;11:296–305.
      1. Nanashima A, Sumida Y, Abo T, Nagayasu T, Sawai T. Usefulness and application of the liver hanging maneuver for anatomical liver resections. World J Surg 2008;32:2070–2076.
      1. Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F, et al. Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 2007;245:31–35.
      1. Trotovsek B, Belghiti J, Gadzijev EM, Ravnik D, Hribernik M. Anatomical basis of the liver hanging maneuver. Hepatogastroenterology 2005;52:728–730.
      1. Tsuruta K, Okamoto A, Toi M, Saji H, Takahashi T. Impact of selective Glisson transection on survival of hepatocellular carcinoma. Hepatogastroenterology 2002;49:1607–1610.
      1. Kim SH, Park SJ, Lee SA, Lee WJ, Park JW, Hong EK, et al. Various liver resections using hanging maneuver by three glisson's pedicles and three hepatic veins. Ann Surg 2007;245:201–205.
      1. Hashikura Y, Kawasaki S. Living donor liver transplantation: issues regarding left liver grafts. HPB (Oxford) 2004;6:99–105.
    MeSH Terms
    Blood Transfusion
    Hepatectomy
    Hospital Mortality
    Humans
    Liver
    Medical Records
    Metrics
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