Hanging Manoeuvre to Facilitate Right Hepatectomy with Control of the Right Hepatic Vein

BACKGOUND

The hanging manoeuvre facilitates right hepatectomy without prior liver mobilisation.¹ This is advantageous when tumour invades the diaphragm.² The disadvantage is that control of retrohepatic venous structures is not prior to parenchymal division. Our modification overcomes this by controlling the right hepatic vein prior to parenchymal division.

TECHNIQUE

The anterior surface of the liver is exposed up to the level of the suprahepatic inferior vena cava and the space between the middle and right hepatic veins dissected. Attention is then turned to the intrahepatic inferior vena cava and a clamp is passed, in a cautious manner, posterior to the caudate lobe cranially towards the space created between the middle and right hepatic veins, keeping to the left of the inferior right hepatic vein. A tape is then grasped with the clamp and passed around the hepatic parenchyma.^{1, 2} This process is then repeated placing a vessel loop alongside the tape. A space is dissected immediately to the right of the right hepatic vein directed towards this tunnel. The distal end of the vessel loop is then drawn alongside the lateral border of the right hepatic vein so that it is encircled. Following parenchymal transection, the right hepatic vein is divided in the usual manner (Fig. 1).

Figure 1.

Illustration of the technique.

DISCUSSION

This modification of the hanging manoeuvre enables control of the right hepatic vein prior to parenchymal transection, avoiding potentially life threatening haemorrhage from inadequate control of the right hepatic vein.