Left Lobe Mobilization Strategy of Right-Sided Major Hepatectomy for Treatment of a Tumor Causing Severe Inferior Vena Cava Compression: A Novel Strategy Using the Modified Liver-Hanging Maneuver

  • Kenichiro Araki
  • Norio Kubo
  • Norihiro Ishii
  • Mariko Tsukagoshi
  • Takamichi Igarashi
  • Akira Watanabe
  • Hiroyuki Kuwano
  • Ken Shirabe
Hepatobiliary Tumors
  • 3 Downloads

Abstract

Background

Massive bleeding during major hepatectomy is associated with greater mortality and morbidity.1 Our previous study shows that inferior vena cava (IVC) compression by tumor and an anterior approach without the liver-hanging maneuver (LHM) are risk factors for massive bleeding.2 The LHM is useful for controlling bleeding in deeper parenchymal transection planes.3 However, severe compression of the IVC by tumor makes it difficult to insert a hanging tape.4 The study shows a novel modified LHM strategy for severe IVC compression to minimize intraoperative bleeding.

Methods

The procedure was disassembled into six steps: (1) the glissonian bifurcation is encircled using an extrahepatic approach (2) the hepatic ligaments are dissected, and the root of each hepatic vein trunk is exposed (3) the left lobe is fully mobilized, and the short hepatic veins are carefully dissected with a systematic procedure established from hemi-left lobe procurement in living donor liver transplantation5 (4) the tape is inserted from the space between the right and middle hepatic vein trunks into the glissonian bifurcation along the anterior surface of the IVC (5) liver parenchymal transection is performed with upward pulling of the tape (6) the right hepatic vein is dissected, and the right lobe is dissected from the diaphragm and the right hepatic ligaments.

Results

Right hepatectomy with this procedure was performed for two patients with IVC compressed by hepatocellular carcinoma. The operative times were respectively 483 and 396 min. The respective estimated blood losses were 1195 and 485 ml, without transfusion. Both patients had acceptable outcomes without complications.

Conclusion

The novel modified LHM strategy ensured minimal bleeding in the resection of a huge liver tumor causing severe IVC compression.

Notes

Acknowledgement

The authors express special thanks to Ms. Sayaka Okada for her excellent illustrations of surgical strategy.

Disclosure

There are no conflicts of interest.

Supplementary material

Supplementary material 1 (WMV 320930 kb)

References

  1. 1.
    Helling TS, Blondeau B, Wittek B. Perioperative factors and outcome associated with massive blood loss during major liver resections. HPB Oxford. 2004;6:181–5.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Shirabe K, Kajiyama K, Harimoto N, Tsujita E, Wakiyama S, Maehara Y. Risk factors for massive bleeding during major hepatectomy. World J Surg. 2010;34:1555–62.CrossRefPubMedGoogle Scholar
  3. 3.
    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;193:109–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F, Sauvanet A. Two hundred liver-hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg. 2007;245:31–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ikegami T, Shirabe K, Soejima Y, et al. Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center. J Am Coll Surg. 2013;216:353–62.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Kenichiro Araki
    • 1
  • Norio Kubo
    • 1
  • Norihiro Ishii
    • 1
  • Mariko Tsukagoshi
    • 1
  • Takamichi Igarashi
    • 1
  • Akira Watanabe
    • 1
  • Hiroyuki Kuwano
    • 2
  • Ken Shirabe
    • 1
  1. 1.Department of Hepatobiliary and Pancreatic SurgeryGunma University Graduate School of MedicineMaebashiJapan
  2. 2.Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan

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