Shuyou Peng, MD, FACS (Hon); Jiangtao Li, MD; Yingbin Liu, MD; Jianwei Wang, MD; Yiping Mou, MD; Xiujun Cai MD; Defei Hong, MD
Introduction: Liver hanging manoeuver has been used frequently for right lobe resection ever since it was described by Belghiti in 2001 for right lobe resection. It has rarely been used for caudate lobe resection. This video is to show the feasibility and advantage of using hanging manoeuvre in caudate lobe resection.
Methods: A 50 year old woman with a history of hepatitis B complaint of upper abdomen discomfort for 3 months. HBsAg(+), AFP(-) CT scan showed a mass in the caudate lobe. During operation retrohepatic tunnel was developed which is just in front of the IVC toward the inter-hepatic-venous fossa which had been dissected previously. A catheter was inserted to follow the withdrawing finger until it appeared at the lower opening of the tunnel. The catheter then became a sling to lift the liver forward. With a special instrument, Peng's Multifunctional Operative Dissector (PMOD), it was easy to isolate and divide the ductal system. The hemangiom was then carefully detached from the left and middle hepatic vein and gradually separated from segment VI and VII.
Results: There was no complication in association with this procedure and the patient recovered uneventfully.
Conclusion: Liver hanging manoeuvre is feasible and useful in isolated complete resection of caudate lobe? 2 PMOD is very helpful in carrying out precise and delicate dissection. 3 The layer of liver parenchyma encasing IVC might not be necessarily be a hindrance to caudate lobe resection.