A Two-Step Hanging Maneuver for a Complete Resection of Couinaud’s Segment I

Abstract

Background: A hepatic resection of Couinaud’s segment I is a challenging procedure because it is located deep in the abdominal cavity and surrounded by large blood vessels. A new technique, called the ‘two-step hanging maneuver,’ was applied to completely resect Couinaud’s segment I. Methods: A 59-year-old male was diagnosed with hepatocellular carcinoma in Couinaud’s segment I. A hanging tape was positioned from the groove between the middle and left hepatic veins to the groove between the right and left Glisson sheaths via the posterior hepatic surface after all short hepatic veins were divided. The liver was split into the left and right hemilivers (step 1). The hanging tape was positioned into the fissure of the ligamentum venosus, then Couinaud’s segment I was completely resected after dividing the liver parenchyma between segments I and IV by hanging the tape medially (step 2). Results: The operation time was 435 min. No blood transfusions were necessary and there were no complications. Conclusion: This technique allowed resection of a tumor located in Couinaud’s segment I without mobilization of the tumor and safely divided the liver parenchyma via only an anterior approach.

Post-hepatectomy Refractory Ascites in Cirrhotic Patients with Hepatocellular Carcinoma: Risk Factor Analysis to Overcome this Problematic Complication

“…Limited hepatic resection and subsegmentectomy of the liver for cirrhotic patients with HCC have been indicated to preserve liver tissue and avoid a liver failure after hepatectomy (11)(12)(13). Various technical methods for parenchymal transection have been developed to reduce intraoperative blood loss (14,15).…”

Two-Step Hanging Maneuver for an Isolated Resection of the Dorsal Sector of the Liver

“…The surgical procedures in Patient 2 were reported previously [15]. The procedures differed in two points from the procedures used in Patient 1: All the short hepatic veins were divided from the right side of the IVC and the liver was split into hemilivers along the left side of the MHV by introducing cotton tape through the groove between the MHV and the LHV.…”