Abstract: Objective: The liver hanging maneuver (LHM) is rarely applied in laparoscopic right hepatectomy (LRH) because of the difficulty encountered in retrohepatic tunnel (RT) dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the goldfinger dissector to create a total RT been reported. This study’s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the goldfinger dissector in LRH. Methods: Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results: The median age of patients was 58 (range, 51–65) years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 (40–150) mm. The median operative time was 320 (282–358) min with a median blood loss of 200 (200–600) ml. Laparoscopic LHM was achieved in a median of 31 (21–62) min, and the median postoperative hospital stay was 14 (9–16) d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions: The goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.

能否运用金手指在腹腔镜右半肝切除术中快速简易建立肝后隧道实行绕肝带提拉？

[1]Belghiti, J., Guevara, O.A., Noun, R., et al., 2001. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J. Am. Coll. Surg., 193(1):109-111.

[2]Beppu, T., Ishiko, T., Chikamoto, A., et al., 2012. Liver hanging maneuver decreases blood loss and operative time in a right-side hepatectomy. Hepatogastroenterology, 59(114):542-545.

[3]Cai, X.J., Li, Z.Y., Zhang, Y.L., et al., 2014. Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg. Endosc., 28(4):1334-1341.

[4]Cai, X.J., Duan, L., Wang, Y.F., et al., 2016. Laparoscopic hepatectomy by curettage and aspiration: a report of 855 cases. Surg. Endosc., 30(7):2904-2913.

[5]Ceelen, W., Walder, J., Cardon, A., et al., 2003. Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann. Surg., 237(1):10-16.

[6]Clavien, P.A., Barkun, J., de Oliveira, M.L., et al., 2009. The Clavien-Dindo classification of surgical complications: five-year experience. Ann. Surg., 250(2):187-196.

[7]Dagher, I., Caillard, C., Proske, J.M., et al., 2008. Laparoscopic right hepatectomy: original technique and results. J. Am. Coll. Surg., 206(4):756-760.

[8]Dagher, I., di Giuro, G.J., Dubrez, J., et al., 2009. Laparoscopic versus open right hepatectomy: a comparative study. Am. J. Surg., 198(2):173-177.

[9]Dokmak, S., Ben Safta, Y., Ftériche, F.S., et al., 2014. Pure laparoscopic right hepatectomy with the hanging maneuver for multiple hepatocellular adenomas. Ann. Surg. Oncol., 21(12):3800-3801.

[10]Gayet, B., Cavaliere, D., Vibert, E., et al., 2007. Totally laparoscopic right hepatectomy. Am. J. Surg., 194(5):685-689.

[11]Han, H.S., Yoon, Y.S., Cho, J.Y., et al., 2010. Laparoscopic right hemihepatectomy for hepatocellular carcinoma. Ann. Surg. Oncol., 17(8):2090-2091.

[12]Kim, J.H., Ryu, D.H., Jang, L.C., et al., 2016. Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections. Surg. Endosc., 30(8):3611-3617.

[13]Lai, E.C.S., Fan, S.T., Lo, C.M., et al., 1996. Anterior approach for difficult major right hepatectomy. World J. Surg., 20(3):314-318.

[14]Lainas, P., Camerlo, A., Conrad, C., et al., 2015. Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: is it feasible and reasonable? Surgery, 158(1):128-134.

[15]Medbery, R.L., Chadid, T.S., Sweeney, J.F., et al., 2014. Laparoscopic vs open right hepatectomy: a value-based analysis. J. Am. Coll. Surg., 218(5):929-939.

[16]Nguyen, K.T., Gamblin, T.C., Geller, D.A., 2009. World review of laparoscopic liver resection—2804 patients. Ann. Surg., 250(5):831-841.

[17]Pearce, N.W., di Fabio, F., Teng, M.J., et al., 2011. Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am. J. Surg., 202(5):e52-e58.

[18]Qin, Q., Wang, L., Li, H., et al., 2012. Efficacy and safety of right hemihepatectomy through the right retrohepatic tunnel. Cell Biochem. Biophys., 62(1):113-118.

[19]Tzanis, D., Shivathirthan, N., Laurent, A., et al., 2013. European experience of laparoscopic major hepatectomy. J. Hepatobiliary Pancreat. Sci., 20(2):120-124.

[20]Wakabayashi, G., Cherqui, D., Geller, D.A., et al., 2015. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann. Surg., 261(4):619-629.

[21]Wang, C.C., Jawade, K., Yap, A.Q., et al., 2010. Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J. Surg., 34(8):1874-1878.

[22]Wu, T.J., Wang, F., Lin, Y.S., et al., 2010. Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br. J. Surg., 97(7):1070-1078.

[23]List of electronic supplementary materials

[24]Fig. S1 Establishing the initial caudal portion of the retrohepatic tunnel (initial cad-RT)

[25]Fig. S2 Establishing the median portion of the retrohepatic tunnel (med-RT)

[26]Fig. S3 Establishing the total retrohepatic tunnel (RT)

[27]Fig. S4 Placement of the hanging tape through the whole retrohepatic tunnel (RT)

[28]Fig. S5 Parenchymal transection of the median hepatic fissure (MHF)

[29]Fig. S6 Achievement of hemostasis after removal of the specimen