Atsushi Nanashima, Masahide Hiyoshi, Naoya Imamura, Koichi Yano, Takeomi Hamada, Eiji Kitamura, Fumiya Kawano

Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan


Objective: Hepatic transection through an anterior approach is required to successfully complete anatomical hepatectomy for large liver malignancies. The liver hanging maneuver (LHM) is an alternative procedure for transection on an adequate cut plane and may reduce intraoperative bleeding and transection times.

Material and Methods: We examined the medical records of 24 patients with large liver malignancies (>5 cm) who had undergone anatomical hepatic resection with LHM (n= 9) or without LHM (n= 15) between 2015 and 2020. Patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcomes were retrospectively compared between the LHM and non-LHM groups.

Results: The prevalence of tumors >10 cm was significantly higher in the LHM group than in the non-LHM group (p< 0.05). Furthermore, LHM was significantly performed to right and extended right hepatectomies in the background normal liver (p< 0.05). Although transection times did not significantly differ between the two groups, the amount of intraoperative blood loss was slightly lower in the LHM group than in the non-LHM group (1.566 mL vs. 2.017 mL), and blood transfusion was not needed for patients in the LHM group. Post-hepatectomy liver failure and bile leakage were not observed in LHM. However, the length of hospitalization was slightly shorter in the LHM group than in the non-LHM group.

Conclusion: LHM is useful for transecting an adequately cut plane in hepatectomy for liver tumors over 5 cm-in-size located on the right side and achieves better outcomes.

Keywords: Large intrahepatic malignancies, anterior hepatectomy, liver hanging maneuver, blood loss

Cite this article as: Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kitamura E, et al. Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm. Turk J Surg 2022; 38 (3): 215-220.


Ethics Committee Approval

The study protocol was approved by the Institutional Review Board of University of Miyazaki (Decision no: C-0898, Date: 18.02.2021). Written and informed consent was obtained from the opt-out method on our website. All study protocols followed guidelines stated in the Declaration of Helsinki.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept – A.N.; Design – A.N.; Supervision – A.N.; Data Collection and/ or Processing – M.H., N.I., K.Y., T.H., E.K., F.K.; Analysis and/or Interpretation – A.N.; Literature Search – A.N.; Writing Manuscript – A.N.; Critical Reviews – A.N., M.H.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.