Topography of Short Hepatic Veins and Interface Veins for Safe Tunneling During Hanging Maneuver of Liver
AbstractIntroduction: During hanging maneuver liver resection, a tunnel is created at the interface of the liver and Inferior venacava (IVC). Gap between the middle and right hepatic vein is known as Fossa venacava. A gap between the Inferior right hepatic vein and the Caudate vein is known as a Vein gap. The Fossa venacava and Vein gap provide a safe plane for the insertion of forceps during tunneling. The aim of this study is to determine the topography of this safe plane.
Methods: A cross-sectional study was done. Twenty livers were used in our study. Major hepatic veins, distance of Vein gap, Fossa venacava, and each vessel present at the interface between liver and IVC was measured by a Vernier caliper. All the collected data was entered and analyzed by using Statistical Package for Social Sciences version 20 (SPSS-20).
Results: The average length of retro hepatic IVC was 49.5±10.5 mm and the diameter of 25.6±4.4 mm. The inferior right hepatic vein was present in 60% of cases while the Caudate vein was present in 85% of cases. Fossa venacava had an average distance of 12.3±3.46 mm and the Vein gap was 18.9±7.1 mm.
Conclusion: While tunneling between IVC and the liver, Fossa venacava could be as small as 4.6 mm. The shortest distance of the Vein gap could be as small as 5.8 mm. The intermediate course of forceps insertion is safer than the right or left course.
2. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver Hanging Maneuver: A Safe Approach To Right Hepatectomy Without Liver Mobilization. Journal of the American College of Surgeons. 2001;193(1):109-11.
3. Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J. The liver hanging maneuver. HPB (Oxford). 2009;11(4):296-305.
4. Zheng W, Zi-Hai D, Jie Z, Shi-Zhen Z, Jian-Hua L, Yi-Xiong L. Anatomy of the retrohepatic tunnel in a Chinese population and its clinical application in liver surgery. Sci Rep. 2017;7:44977.
5. Joshi SD, Joshi SS, Siddiqui AU. Anatomy of retrohepatic segment of inferior venacava and termination of hepatic veins. Indian J Gastroenterol. 2009;28(6):216-20.
6. Sato TJ, Hirai I, Murakami G, Kanamura T, Hata F, Hirata K. An anatomical study of short hepatic veins, with special reference to delineation of the caudate lobe for hanging maneuver of the liver without the usual mobilization. J Hepatobiliary Pancreat Surg. 2002;9(1):55-60.
7. Qiu ZQ, Tan WF, Yan PN, Luo XJ, Zhang BH, Wu MC, et al. Early control of short hepatic portal veins in isolated or combined hepatic caudate lobectomy. Hepatobiliary Pancreat Dis Int. 2012;11(4):377-82.
8. Hirai I, Murakami G, Kimura W, Kanamura T, Sato I. How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study. Clin Anat. 2003;16(3):224-32.
9. Morjane A, Dahmane R, Ravnik D, Hribernik M. Anatomy and surgical relevance of the hepatocaval ligament. A study on cadaveric livers. Cells Tissues Organs. 2008;187(3):243-6.
10. Makdissi FF, Mattos BVHd, Kruger JAP, Jeismann VB, Coelho FF, Herman P. 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. 2021;8.
11. Lin TY. Hepatic tumors, surgical treatment and its results. Jpn J Surg. 1977;7(4):189-98.
12. Bundi PK, Hassanali J, Odula PO. Topography and distribution of ostia venae hepatica in the retrohepatic inferior venacava. Annals of African Surgery. 2009;4(2009):13-7.
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