Applied Anatomical and Experimental Study of Retrohepatic Tunnel of Liver Hanging Maneuver_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Junfeng ¹ , MO Yiwo ¹ , WANG Yankun ¹ , SUN Zhiwei ¹ , LI Xinguo ² , FAN Wei ³ , WANG Xiaoyun ¹ , JIN Yan ¹ , ZHANG Xinjun ¹ , XU Jing ¹ , LIU Jun ¹

Department of Hepatobiliary Surgery, The First People’s Hospital of Yunnan Province, Kunming 650032, China;

Corresponding author：

Keywords：

Liver hanging maneuver; Retrohepatic tunnel; Applied anatomy

Video：

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Objective 　To study the clinical anatomical basis of the liver hanging maneuver through research of applied anatomy.
Methods 　Retrohepatic portions of the inferior vena cava of 21 cadaver were observed intracavitarily, and the numbers of short hepatic vein (SHV) opening were counted based on different possible pathway of the liver hanging maneuver and different width of retrohepatic tunnel (10 mm, 6 mm).
Results 　The number of SHV was 0 to 3 (median=1) using standard pathway of the liver hanging maneuver in 6 mm retrohepatic tunnel, and the number of SHV was 0 to 2 (median=0) using EM pathway that was on the right border of retrohepatic portion of the inferior vena cava and 1 cm away from the inferior border of liver. There was a significant difference between the EM pathway and standard pathway, P=0.003.
Conclusion 　The results show that setting up a retrohepatic tunnel through the liver hanging maneuver is feasible and safe.

Citation： WANG Junfeng,MO Yiwo,WANG Yankun,SUN Zhiwei,LI Xinguo,FAN Wei,WANG Xiaoyun,JIN Yan,ZHANG Xinjun,XU Jing,LIU Jun. Applied Anatomical and Experimental Study of Retrohepatic Tunnel of Liver Hanging Maneuver. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(5): 569-572. doi: Copy

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1. 　Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization [J]. J Am Coll Surg, 2001; 193(1)∶109.
2. 　Kokudo N, Sugawara Y, Imamura H, et al. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique [J]. Transplantation, 2003; 76(5)∶803.
3. 　Ettorre GM, Vennarecci G, Lonardo MT, et al. The modified “hanging maneuver” during orthotopic liver transplantation using a technique for conserving the inferior vena cava [J]. Tumori, 2003; 89(4 Suppl)∶63.
4. 　彭淑牖，曹利平，李江涛，等. 肝后隧道的建立与绕肝带的使用在高难度肝切除术中的作用 [J]. 中华医学杂志, 2003; 83(19)∶1644.
5. 　Lai EC, Fan ST, Lo CM, et al. Anterior approach for difficult major right hepatectomy [J]. World J Surg, 1996; 20(3)∶314.
6. 　吴孟超. 肝癌外科治疗的近期进展 [J]. 中国普外基础与临床杂志, 2006; 13(2)∶125.
7. 　王鲁，孙惠川，钦伦秀，等. 肝癌解剖性肝切除的初步经验 [J]. 中国普外基础与临床杂志, 2007; 14(1)∶39.
8. 　王学浩, 姜超. 活体肝移植的现状和发展 [J]. 中国普外基础与临床杂志, 2005; 12(2)∶100.
9. 　彭淑牖, 牟一平. 肝中裂分离高位胆管狭窄修复术 [A]. 黄志强主编. 腹部外科手术学 [M]. 第1版. 长沙: 湖南科技出版社, 2001∶974~977.
10. 　钟世镇主编. 临床解剖学 [M]. 北京: 人民军医出版社, 1998∶355～356.
11. 　Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet， 1981; 152(1)∶43.
12. 　Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection [J]. Surg Gynecol Obstet, 1957; 105(3)∶310.
13. 　张我华，孙善全. 肝静脉口和下腔静脉肝后段的应用解剖研究 [J]. 中华外科杂志， 1984； 22（9）∶563.
14. 　Fong Y, Blumgart LH. Useful stapling techniques in liver surgery [J]. J Am Coll Surg, 1997; 185(1)∶93.
15. 　Mehran R, Schneider R, Franchebois P. The minor hepatic veins: anatomy and classification[J]. Clin Anat, 2000; 13(6)∶416.
16. 　Cheng YF, Huang TL, Chen CL, et al. Variations of the middle and inferior right hepatic vein: application in hepatectomy [J]. J Clin Ultrasound, 1997; 25(4)∶175.
17. 　Meng WC, Shao CX, Mak KL, et al. Anatomical justification of Belghiti’s ‘liver hanging manoeuvre’ in right hepatectomy with anterior approach [J]. ANZ J Surg, 2003; 73(6)∶407.
18. 　Sato TJ, Hirai I, Murakami G, et al. An anatomical study of short hepatic veins, with special reference to delineation of the caudate lobe for hanging maneuver of the liver without the usual mobilization [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1)∶55.
19. 　Hirai I, Murakami G, Kimura W, et al. How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study [J]. Clin Anat, 2003; 16(3)∶224.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Applied Anatomical and Experimental Study of Retrohepatic Tunnel of Liver Hanging Maneuver

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