Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

Abstract

Abstract. Liver resections are safe when performed by specialized hepatobiliary teams. However, complex liver resections are accompanied by significant perioperative risk and they may require modifications of the conventional surgical techniques. We herein report the case of a 54-year-old male patient who underwent an extended right liver resection with en bloc resection and reconstruction of the inferior vena cava. For this complex resection, a modification of the standard operative technique was required. A modified hanging manoeuvre was performed using two 19Fr nasogastric tubes outside the traditional avascular plane to facilitate resection. This modification of the hanging manoeuvre was proven to be feasible and safe, and it is recommended for inclusion in the armamentarium of hepatobiliary surgeons when complex resections are required.

Surgical relevance of anatomic variations of the right hepatic vein

“…Although relatively wide in diameter (20.4 mm), a type I SRHV is easier to expose and control outside the liver intraoperatively. It also facilitates the hanging maneuver, where an instrument is passed along the avascular space over the retrohepatic IVC and guided between the right and middle hepatic veins[ 20 ]. A longer SRHV allows more separation between the liver and the HCJ, making it is easier for the surgeon to navigate the instrument between the hepatic veins.…”

“…A longer SRHV allows more separation between the liver and the HCJ, making it is easier for the surgeon to navigate the instrument between the hepatic veins. That maneuver can facilitate liver resections by reducing bleeding during parenchymal transection and guide the transection line[ 20 ]. A longer extrahepatic vein makes right lobe donation and recipient implantation technically easier.…”