Safe bile duct division in right lateral sector graft.
OBJECTIVE
Right lateral sector (RLS, segments VI and VII according to Couinaud's nomenclature for liver segmentation) graft was introduced as an alternative liver graft. The authors report their surgical techniques for bile duct division in RLS graft harvest.


METHODS
Between January 2000 and December 2001, 11 donors provided their RLS. Intraoperative cholangiography was performed and the anatomy of the upper biliary confluence was confirmed. When the right lateral duct entered the common bile duct (caudal right lateral duct), the duct was divided at its root in situ. In other situations, the right portal branch was first dissected and taped. With the right portal branch pulled cranially, the right lateral duct was dissected from surrounding connective tissues and divided as long as possible.


RESULTS
Cholangiography revealed various right lateral duct anatomies, such as entering the right duct (n=6), the left and right bifurcation (n=2), the common bile duct (n=2) and the left duct (n=1). The postoperative course was uneventful in all donors. All of the patients survived the operation.


CONCLUSIONS
Careful attention should be paid to bile duct division in donor hepatectomy. The present technique can ensure a safe harvest of RLS graft with a long right lateral duct.
Sugawara
Yasuhiko
Y
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine University of Tokyo, Tokyo, Japan. yasusuga-tky@umin.ac.jp
Matsui
Yuichi
Y
Noritomi
Tomoaki
T
Kaneko
Junichi
J
Makuuchi
Masatoshi
M
D000293:Adolescent; D000328:Adult; D001652:Bile Ducts / Q000033:anatomy & histology / Q000601:surgery*; D002675:Child, Preschool; D004210:Dissection / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020858:Tissue and Organ Harvesting / Q000379:methods*