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Kim, Park, Park, and Lee: Clinical Application of Hepatic Resection Using Glissonean Pedicle Transection Method and Hanging Maneuver
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(2): 122-129.

Published online: 2 August 2010

DOI: https://doi.org/10.4174/jkss.2010.79.2.122

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, 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 (yjlee@amc.seoul.kr)

Received 10 March 2010       Accepted 6 April 2010

Copyright © 2010 The Korean Surgical Society

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 and Tables

Fig. 1
Various hepatectomy using hanging maneuver clearly increased according to year, especially left side hepatectomy. Rt = right side hepatectomy; Lt = left side hepatectomy.
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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.
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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.
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Table 1
Clinicopathologic features of patients with malignant liver tumors
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*HCC = hepatocellular carcinoma; †ICC = intrahepatic cholangiocarcinoma; ‡ICG at 15 min = indocyanine green retention rate at 15 min; §HBs Ag = hepatitis B antigen; ∥HCV Ab = hepatitis C antibody.

Table 2
Types of hepatectomy using hanging maneuver
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*MHV = middle hepatic vein.

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