Clinical Application of the Right Liver Hanging Maneuver for Laparoscopic Resection of Segment 6 Hepatocellular Carcinoma

Introduction: Laparoscopic resection of liver segment 6 has gradually become widely applied. Nevertheless, several intraoperative challenges persist, primarily concerning adequate visual exposure, restricted operative workspace, and precise hemorrhage management under laparoscopy. These difficulties are particularly pronounced in patients with concurrent liver cirrhosis, where surgical risk is markedly amplified. The liver hanging maneuver (LHM), originally devised for extensive right hemiliver tumor resections. In recent years, LHM technology has evolved into several versions and has been applied in laparoscopic liver resection surgeries but remain limited.In this study, a new modified form of the LHM was employed in two patients presenting with liver cirrhosis and segment 6 hepatocellular carcinoma (HCC), facilitating efficient laparoscopic liver resection (LLR). This modified approach was designated as the right liver hanging maneuver (RLHM). The surgical procedure went smoothly, and the short-term outcomes were satisfactory. Therefore, this method is presented herein. Case Presentation: Two patients preoperatively diagnosed with HCC secondary to hepatitis B-related cirrhosis underwent laparoscopic segment 6 resection. One case involved decompensated cirrhosis with Child-Pugh grade B hepatic function, whereas the other case was a 72-year-old individual with multiple comorbidities, including hypertension, coronary heart disease, and diabetes mellitus. During the procedure, the RLHM technique, in conjunction with intraoperative ultrasonography, enabled rapid and complete tumor excision. Intraoperative blood loss in both cases remained below 100 mL, no transfusion was necessary, and postoperative outcomes were favorable. Conclusion: This report highlights the advantages of the RLHM technique for liver cirrhosis patients with Segment 6 HCC. It is suggested to conduct further extensive research to confirm safety and feasibility.