A Combined “Hanging Liver Maneuver” and “Intrahepatic Extra-Glissonian Approach” for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy

Frontiers in Surgery

article

Fabio Ferrari Makdissi¹  Jaime Arthur Pirola Kruger¹  Vagner Birk Jeismann¹  Fabricio Ferreira Coelho¹  Paulo Herman¹ 

[1] Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo School of Medicine

关键词: hepatectomy;    colorectal liver metastasis;    hanging liver maneuver;    intrahepatic glissonian approach;    portal pedicle;    anatomy;   

DOI  :  10.3389/fsurg.2021.690408

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients. Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed. Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%. Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients.

【 授权许可】

CC BY