Is cholangiography required for ex situ splitting of cadaveric livers?

Anomalous biliary anatomy is encountered frequently and, if not considered at the time of ex situ splitting of a cadaveric liver into left lateral segment and right lobe grafts, right-sided second-order ducts that enter the left system, or the segment IV duct, may be damaged, leading to biliary complications in the recipients. Bench cholangiography facilitates delineation of these anomalies, but if one considers the commonly encountered variations in biliary anatomy, in relation to the correct plane of division of the left hepatic duct (away from the hilum, close to the umbilical fissure), it is possible to avoid inadvertent injury to right-sided sectoral ducts. This approach, combined with careful probing of the ducts and absolute identification of the segment IV duct negates the contribution of cholangiography.