Open Hepatic Transection Using Chang’s Needle

Abstract

Chang’s needle is a long needle for sewing the entire thickness of the liver tissue in one row using intermittent mattress sutures. In this fashion, all the intrahepatic inflows and backflows can be secured without using the traditional Pringle’s maneuver before starting a liver parenchyma transection. Alternatively, it can be applied to any specified regional inflows and backflows (Chang’s maneuver), under ultrasonographic guidance as well, for small tumor resection and to localize or minimize ischemia and reperfusion in the target area. When compared with Pringle’s maneuver or other kinds of inflow control, use of Chang’s maneuver allows maximal reduction of ischemic and reperfusion injuries, which will be beneficial to an already taxed cirrhotic liver. A straight needle cannot be used for tumors near or over the inferior vena cava. Currently, a curved needle is being developed to overcome such problems, as well as to secure inflow and backflow before laparoscopic liver transection. The advantages of using Chang’s needle for Chang’s maneuver are that it is simple and inexpensive, causes fewer hemorrhages and fewer ischemic and reperfusion injuries, requires less training, and incurs lower medical expenses.