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

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.