A two-step hanging maneuver for a complete resection of Couinaud's segment i

Hideaki Uchiyama, Shinji Itoh, Takahiro Higashi, Daisuke Korenaga, Kenji Takenaka

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: A hepatic resection of Couinaud's segment I is a challenging procedure because it is located deep in the abdominal cavity and surrounded by large blood vessels. A new technique, called the 'two-step hanging maneuver,' was applied to completely resect Couinaud's segment I. Methods: A 59-year-old male was diagnosed with hepatocellular carcinoma in Couinaud's segment I. A hanging tape was positioned from the groove between the middle and left hepatic veins to the groove between the right and left Glisson sheaths via the posterior hepatic surface after all short hepatic veins were divided. The liver was split into the left and right hemilivers (step 1). The hanging tape was positioned into the fissure of the ligamentum venosus, then Couinaud's segment I was completely resected after dividing the liver parenchyma between segments I and IV by hanging the tape medially (step 2). Results: The operation time was 435 min. No blood transfusions were necessary and there were no complications. Conclusion: This technique allowed resection of a tumor located in Couinaud's segment I without mobilization of the tumor and safely divided the liver parenchyma via only an anterior approach.

Original languageEnglish
Pages (from-to)202-205
Number of pages4
JournalDigestive surgery
Issue number3
Publication statusPublished - Aug 2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology


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