A secured technique for bile duct division during living donor right hepatectomy

✍ Scribed by Mitsuhisa Takatsuki; Susumu Eguchi; Hirotaka Tokai; Masaaki Hidaka; Akihiko Soyama; Yoshitsugu Tajima; Takashi Kanematsu

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 364 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20877

✦ Synopsis

Although biliary complication is well recognized as a significant factor affecting patient/graft morbidity, and the procedure and outcome of bile duct reconstruction in the recipient has been fully discussed, 1,2 the technical details of bile duct division in living donor hepatectomy have not yet been described. Especially in the case of right lobe living donor liver transplantation, the incidence of multiple bile ducts in the graft is high, up to 80% in previous reports, 3,4 and several studies have indicated that multiple bile ducts in the graft is a risk factor for biliary complication in the recipient. 5,6 Accordingly, we should cut the bile duct as close as possible to the common hepatic duct, but biliary stricture in the remnant liver of the donor is a great concern. To overcome these problems, we describe our technical inventions for safe and accurate bile duct division during living donor right hepatectomy.

During hilar dissection, the right hepatic artery and right portal vein are fully exposed and isolated from the hilar plate. At the final step of subsequent parenchymal transection, the right hilar plate is fully exposed and encircled with radiopaque marker filament, which is obtained from surgical gauze (Fig. 1). Intraoperative cholangiography is then performed via a catheter placed in the cystic duct (Fig. 2A). C-arm fluoroscopy is adapted during this procedure to enable us to check the optimal cutting point of the bile duct, which is made clear by pulling the filament and