How to do: technique of liver hanging maneuver—step by step

In 2001, Belghiti et al. described a technique called “liver hanging maneuver” (LHM): consisting in lifting the liver during parenchymal transection by a tape passed between the anterior surface of inferior vena cava (IVC) and the liver. In this manner surgeons achieve the effective vascular control especially for the deeper parenchymal transection and a guidance of the direction of anatomic parenchymal transection. LHM can be performed due to the existence of a longitudinal avascular and virtual space between anteriorly the posterior face of liver and posteriorly the anterior face of IVC. We use this method, which is adopted routinely by the Reims Team, and is it similar to the one described by Belghiti with some peculiarities: it is a combined bidirectional up and down (or cranio-caudal) approach. We show step by step how to perform a safety LHM. We adopted a dissection of the avascular space using: (I) smooth and gently movements; (II) hydro-dissection; (III) 14 Fr nasogastric tube. We think our video can help surgeons especially junior surgeons to understand better LHM and maybe to reproduce it more facility, reducing any risks correlated to this maneuver.