The “Tenting Sign of the Hepatic Vein” Is Important for Laparoscopic Anatomical Hepatectomy Along the Major Hepatic Vein

Naokazu Chiba, Yuta Abe, Masashi Nakagawa, Itsuki Koganezawa, Kei Yokozuka, Toshimichi Kobayashi, Kosuke Hikita, Yosuke Ozawa, Toru Sano, Koichi Tomita, Rina Tsutsui, Shigeyuki Kawachi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Laparoscopic hepatectomy has rapidly evolved and has become a viable alternative to open hepatectomy. However, the dissection of liver parenchyma via the laparoscopic caudal approach (parenchymal transection from the caudal to cranial direction under a laparoscopic caudal view) has several limitations. To avoid these limitations in anatomical hepatectomy along the hepatic vein with the caudal approach, it is important to recognize the “tenting sign of the hepatic vein,” which helps to identify the running of the main trunk of the hepatic vein. Technical Presentation: In the bifurcation of the hepatic vein, there is a possibility of splitting of the hepatic vein branch or disorientation between the main trunk and branch. Therefore, it is vital that when the branch is pulled, the main trunk of the hepatic vein appears to be toward the direction of the branch. As a result, the main trunk appears in the direction from the original route to the pseudo route. In the caudal approach, this phenomenon is called “tenting sign of the hepatic vein.” Therefore, liver dissection should be performed in the contralateral and cranial sides of the main trunk, with the “tenting sign of the hepatic vein” in mind. This report describes specific cases of the “tenting sign of the hepatic vein.” Conclusion: The “tenting sign of the hepatic vein” from the caudal approach is essential knowledge for safe and reliable anatomical laparoscopic hepatectomy and can lead to expansion of indications in the future.

Original languageEnglish
Pages (from-to)1448-1451
Number of pages4
JournalJournal of Gastrointestinal Surgery
Volume24
Issue number6
DOIs
Publication statusPublished - 2020 Jun 1

Keywords

  • Laparoscopic anatomical hepatectomy
  • Tenting sign of the hepatic vein

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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