Anatomical basis of liver hanging maneuver: a clinical and anatomical in vivo study.

Liver Hanging Maneuver (LHM) provides better exposure of the deeper section plane together with Inferior Vena Cava (IVC) protection during right hepatectomies without primary liver mobilization. This study assessed the feasibility and complication rates of LHM focusing on the anatomical distribution of the accessory hepatic veins in the retrohepatic portion of the IVC. From January 2002 to December 2005, LHM was planned in 49 consecutive major hepatectomies. The IVC retrohepatic portion was studied during the anhepatic phase in 17 liver transplantations with IVC preservation. The diameter and location of the vein openings were recorded after IVC division into nine portions. LHM was achieved in 47/49 patients (96%). Bleeding occurred in only one patient (2%) and did not entail procedure interruption. The anatomical study revealed a total of 86 veins present in 17 cases (5.18 +/- 4 per patient) and classified them according to diameter (<3, 3 to 6, and >6 mm), as small (n=40), medium (n=29), and large (n=17), respectively. Nine openings were found in the avascular channel for 6/17 (35%) patients (small n=6, medium n=3, large n=0). LHM is a highly feasible procedure with minor bleeding risks due to the lower density and small diameter of short hepatic veins and caudate veins present in the avascular channel.