title: Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation.
abstract: In living-donor liver transplantation (LDLT), reconstruction of the hepatic artery is challenging because the recipient artery is located deep in the abdominal cavity and the operating field is limited. Also, the hepatic artery of the graft is short and the recipient artery is occasionally damaged. To overcome these difficulties, we developed a double-needle microsuture technique for artery reconstruction. A total of 161 adult patients received 163 LDLTs using this new technique. The first suture was placed at the most difficult point in the artery to be visualized through the microscope. Each stitch was placed from the inner side of the arterial wall to the outer side. The posterior stitch was tied pulling toward the back. The subsequent sutures were advanced anteriorly on either side adjacent to the previous suture. Hepatic artery thrombosis occurred in 4 patients (2.5%), only 2 (1.2%) of which were associated with arterial reconstruction. Intimal dissection developed in the recipient artery in 2 patients (1.2%). Three (50%) of these 6 complications occurred more than 10 days after LDLT. In conclusion, this suturing technique allows for safe intimal adaptation even when the arterial tunica intima is separated from the tunica media, because all stitches are carried from inside of the vessel to the outside, contributing to more satisfactory results.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Asato
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakatsuka
authors.forename: Shunji
authors.initials: S
authors.lastname: Sarukawa
authors.forename: Keita
authors.initials: K
authors.lastname: Inoue
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods