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

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.