PMC7566195_01
The three-dimensional imaging based on computed tomography showed mucinous cystic neoplasm, located at the segment III in the form of compressing the root of the Glissonean pedicle of segment III. MHV, middle hepatic vein; LHV, left hepatic vein; and G3, Glissonean pedicle of segment III.
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III in the form of compressing the root of the Glissonean pedicle of segment III (Fig. 1). In addition, the computed tomography and magnetic resonance imaging revealed the potential risk of malignancy, therefore we decided to perform laparoscopic left hepatecomy instead of left lateral sectionectomy.
Trocar placement using 4 trocars technique for laparoscopic left hemihepatectomy. P, Pringle's maneuver.
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Four trocars technique was introduced at the umbilical portion for the camera and the both subcostal areas for the operator and assistant (Fig. 2). Intermittent Pringle's maneuver was applied for inflow control using a tourniquet system at the right subcostal area (Fig. 2).
The overview of a novel modified hanging maneuver technique.
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Fig. 3. For this hanging technique, the upper edge of the hanging tape was placed on the lateral side of the LHV, and fixed with the Falciform ligament using clips (Fig. 4a).
a The upper edge of the hanging tape was placed on the lateral side of the LHV, and fixed with the Falciform ligament using clips. b The hanging tape was positioned along the left side of the middle hepatic vein, and the lower edge of the hanging tape was extracted along the tourniquet for the Pringle's maneuver.
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Fig. 3. For this hanging technique, the upper edge of the hanging tape was placed on the lateral side of the LHV, and fixed with the Falciform ligament using clips (Fig. 4a). The hanging tape was positioned along the left side of the middle hepatic vein, and the lower edge of the hanging tape was extracted along the tourniquet for the Pringle's maneuver (Fig. 4b).