Background: An anatomical study was carried out to evaluate the safety of the liver hanging maneuver for the right hemiliver in living donor and in situ splitting transplantation. During this procedure a 4-6 cm blind dissection is performed between the inferior vena cava and the liver. Short subhepatic veins entering the inferior vena cava from segments 1 and 9 could be torn with consequent hemorrhage.
Materials and methods: One hundred corrosive casts of livers were evaluated to establish the position and diameter of short subhepatic veins and the inferior right hepatic vein.
Results: The average distance from the right border of the inferior vena cava to the opening of segment 1 veins was 16.7+/-3.4 mm and to the entrance of segment 9 veins was 5.0+/-0.5 mm. The width of the narrowest point on the route of blind dissection was determined, with the average value being 8.7+/-2.3 mm (range 2-15 mm).
Discussion: The results show that the liver hanging maneuver is a safe procedure. A proposed route of dissection minimizes the risk of disrupting short subhepatic veins (7%).