RFA assisted liver resection combined with hanging manoeuvre: The alternative option for safe and bloodless major hepatectomy

Background Major and complex liver resections constitute a particular group of demanding operations which can be easily complicated by severe haemorrhage during vascular approach and liver resection, even when performed by experienced liver surgeons. In order to reduce bleeding, various surgical devices and manoeuvres have been used. Radiofrequency assisted (RFA) liver resection is a relatively new method of transecting the liver parenchyma with favourable intra- and perioperative results. Furthermore, in experienced hands, the hanging manoeuvre technique facilitates major hepatectomy with an “anterior approach,” reducing several risks caused by liver mobilization. The combination of these techniques allows the achievement of bloodless hepatectomy without vascular occlusions and the consequences of complications. Methods A right hemihepatectomy for colorectal liver metastases using a new radiofrequency generator (Surtron SB O) combined with the hanging manoeuvre was performed. The technique consisted of two parallel applications of the comb and a completely bloodless parenchymal transection with a scalpel along the second line. Results Operative time was 245 minutes, intraoperative blood loss was 120 ml, and transection blood loss was 70 ml. Conclusion In our case, the combined use of an RF generator and hanging manoeuvre in right hemihepatectomy provided a bloodless, safe, and relatively rapid parenchymal transection. Enhanced exposure contributes to better haemostasis and permits optimal allocation of the comb with protection of the IVC from injuries. Prospective and randomized studies are needed to compare this technique with the standard procedure.