Supplementary Material for: 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.

背景：库安德Ⅰ段（Couinaud’s segment I）肝切除术极具挑战性，因其深居于腹腔内且被大血管包绕。一种名为“两步悬吊法（two-step hanging maneuver）”的新技术被应用于完全切除库安德Ⅰ段。
方法：1例59岁男性患者被诊断为库安德Ⅰ段肝细胞癌（hepatocellular carcinoma）。在离断所有肝短静脉后，将悬吊胶带经肝后表面从肝中静脉与肝左静脉之间的沟穿至右、左格利森鞘（Glisson sheaths）之间的沟，将肝脏分离为左、右半肝（步骤1）。将悬吊胶带置入静脉韧带裂，随后通过向内侧牵拉胶带离断Ⅰ段与Ⅳ段之间的肝实质，完成库安德Ⅰ段的完全切除（步骤2）。
结果：手术时长为435分钟，无需输血，且未出现任何并发症。
结论：该技术可在无需牵拉肿瘤的情况下切除库安德Ⅰ段内的肿瘤，且仅通过前入路即可安全离断肝实质。