[Autostatic hepatic retractor in orthotopic liver transplantation]

Liver transplantation (LT) is the treatment of choice for acute and chronic liver failure, for hepatocarcinoma and for same metabolic diseases. The shortage of donors leads to use over 60 tears-old donors and to develop new surgical technique to split the liver in 2 grafts. In our institution we set 2 targets: 1) to improve the number of liver transplantations using in situ split liver grafts and old donors, 2) to simplify the surgical technique. Since 1997 we performed 174 LT: 73 with whole size graft from under 60 years old donors, 42 with whole size graft from over 60 years old donors and 59 with split liver grafts. The autostatic hepatic retractor (AHR) was designed to make easier the hepatic hilar dissection and the vascular and biliar anastomoses. The particular steel plate of AHR lifts the inferior surface of the right and left hepatic lobes laying out the hilum to the porta hepatis; its malleability makes possible prolonged atraumatic use in accordance with the anatomical conformation of the liver. AHR is used in LT during the dissection of the left and right hepatic arteries, the dissection of the main portal trunk and its left and right branches, the isolation of the hepatic bile duct; moreover AHF is employed for portal, arterial and biliar anastomoses. In our experience the use of AHR was easy, safe and useful. AHR can help the surgeon during hepato-biliary surgery whenever hilar dissection is required.