Background: s/Aims: Posterosuperior (PS) liver resections present technical challenges, and there is limited evidence on the use of intercostal (IC) trocars. This study aims to describe our technique and assess its feasibility and safety in a series of patients undergoing laparoscopic liver resection (LLR). Methods: We conducted a single-center retrospective analysis between 2022 to 2025. Among 40 patients who underwent LLR of PS segments, an accessory right IC 5-mm port was utilized in 8 cases. Outcomes evaluated included intraoperative complications, conversion rates, blood loss, operative time, length of hospital stay, 90-day morbidity/mortality, and margin status. Results: Eight patients (62.5% female; mean age 50.5 ± 21.39 years; median body mass index 22.27 [IQR 20.8–29.81]) underwent LLR utilizing a single 5-mm IC port. The indications for surgery were liver adenoma (n = 3), colorectal liver metastases (n = 3), neuroendocrine tumor metastasis (n = 1), and hepatolithiasis (n = 1). The mean operative time was 422.5 ± 127.56 minutes, with a mean blood loss of 153.75 ± 58.29 mL, and no transfusions were necessary. There were no intraoperative complications, conversions, or deaths. All patients achieved negative margins (mean 10.25 ± 1.5 mm). The mean length of hospital stay was 4.5 ± 0.93 days, and the 90-day morbidity rate was 0%. Conclusions The use of a small IC port in LLR for PS segments is both feasible and safe, offering improved exposure without increasing morbidity. Larger, multicenter prospective studies are needed to validate these findings and to standardize indications, port size, and placement.

The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified “Loop-Hanging” maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis.Our “Loop-Hanging” technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury.Further research is required to assess its safety and broader applicability.

The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified “Loop-Hanging” maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis.Our “Loop-Hanging” technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury.Further research is required to assess its safety and broader applicability.

The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified “Loop-Hanging” maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis.Our “Loop-Hanging” technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury.Further research is required to assess its safety and broader applicability.