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Anatomical keys and pitfalls in living donor liver transplantation
H Imamura1, M Makuuchi, Y Sakamoto
1Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Insights
Living donor liver transplantation is complex due to anatomical variations. This study details surgical strategies and anatomical insights from extensive experience to improve outcomes in these challenging procedures.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Surgical Anatomy
Background:
- Living donor liver transplantation (LDLT) presents greater technical challenges than cadaveric transplantation or liver resection.
- Successful LDLT hinges on a deep understanding of intra- and extra-hepatic vascular and biliary anatomy and their physiological roles.
- Anatomical anomalies frequently complicate LDLT, demanding sophisticated detection and management techniques.
Purpose of the Study:
- To elucidate the critical anatomical considerations and potential pitfalls in living donor liver transplantation surgery.
- To share practical surgical techniques and insights derived from extensive clinical experience.
- To detail the rationale and application of selective intermittent vascular occlusion methods.
Main Methods:
- Review of surgical experience with over 1800 hepatectomies and 150 living donor liver transplantations.
- Detailed description of anatomical relationships and variations relevant to LDLT.
- Elaboration on techniques for selective intermittent vascular occlusion.
Main Results:
- Identification of key anatomical "keys" and "pitfalls" in LDLT.
- Demonstration of strategies for managing anatomical anomalies during LDLT.
- Explanation of the teleological and practical aspects of selective intermittent vascular occlusion.
Conclusions:
- A comprehensive understanding of surgical anatomy is paramount for successful living donor liver transplantation.
- Proactive identification and management of anatomical variations are crucial for mitigating surgical risks.
- Advanced techniques like selective intermittent vascular occlusion offer valuable tools for complex LDLT cases.
Abstract:
The surgery of living donor liver transplantation is more technically challenging than cadaveric whole liver transplantation and liver resection for the treatment of various pathological conditions. It requires a thorough understanding of the intra- and extra-hepatic anatomical relationships between the portal vein, hepatic artery, biliary tract, and hepatic vein, and also their respective contributions to liver physiology. Although a precise understanding of general anatomical principles is the key to correctly performing living donor liver transplantation procedures, anatomic anomalies are often present, and the means of detecting them and the surgical methods of coping with them represent technical challenges. In this monograph, we describe the anatomical keys and pitfalls of living donor liver transplantation surgery based on our own experience with more than 1800 hepatectomies, and 150 living donor liver transplantations. We also elaborate on techniques of selective intermittent vascular occlusion and their teleological and practical background.