A modified liver hanging maneuver in pure laparoscopic extended left hepatectomy (with video)

Abstract Background Laparoscopic extended left hepatectomy has rarely been reported because of technical difficulties. In this study, we describe the surgical technique of laparoscopic extended left hepatectomy using a modified liver hanging maneuver (LHM). Methods The upper end of the hanging tape was positioned to the lateral aspect of the left hepatic vein (LHV), and the pathway was positioned with the ligamentum venosum. The liver was transected from the Cantlie line to the right side of the middle hepatic vein (MHV) without using the hanging technique. The lower end of the tape was repositioned to the groove created along the right side of the MHV after the initial parenchymal transection. The remnant liver was transected using the hanging maneuver. The hanging tape encircled the common trunk of the LHV and MHV. Results Three patients underwent laparoscopic extended left hepatectomy using the LHM. The median operation time was 310 minutes (range, 260 to 350 minutes), and the median estimated blood loss was 110 mL (range, 90 to 260 mL). The median postoperative hospital stay was 7 days (range, 7 to 8 days). No postoperative morbidity or mortality was observed. Conclusion This modified LHM may be a safe and useful method for laparoscopic extended left hepatectomy.