[Exploration of surgical technique used to donor hepatectomy for adult to adult living donor liver transplantation with right liver lobe graft].
OBJECTIVE
To study the surgical technique of donor hepatectomy for living donor liver transplantation (LDLT).


METHODS
From March 2002 to July 2006, the donor hepatectomy was performed to 47 LDLT without middle hepatic vein (MHV) at West China Hospital. The donors were assessed by 3-dimensional computed tomography (CT) preoperatively. Techniques of cut-ultrasound aspiration (cusa) and electrocautery combining with bipolar coagulation were applied to donor hepatectomy. During the parenchymal transection of donor liver, all major (diameter>5 mm) outflows of segment V (V5), segmentV (V8) and inferior right hepatic vein (IRHV) were preserved for future reconstruction.


RESULTS
No severe complications and death occurred in all the donors. The median operative time was 425 min (range 380-620 min), the average blood loss during the operation was 345 mL (range 250-735 mL), the average intraoperative self-transfusion was 263 mL (range 0-500 mL), but 4 cases of donors needed the blood transfusion intraoperatively. Since 2004, it has become a routine not to transfuse blood into the donor during grafting operation of liver. Complications of liver graft operation occurred in 4 patients including wound steatolysis (2 cases), chyle leakage (1 case), portal vein thrombosis (1 case), and of all 47 donors, 27 cases with big V5, V8 or IRHV were made the vein outflow ducts reconstructed. All operated donors were followed up until today, and all work and live as usual.


CONCLUSIONS
During the donor operation, it is safe and reliable to the hepatectomy performed by the CUSA and electrocautery combining with bipolar coagulation. And the enough outflow reconstruction for LDLT without MHV have made the donor hepatectomy operation become excellent, which suggests that the surgical operative method should be applied and popularized.
Zeng
Yong
Y
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Yan
Lü-nan
LN
Li
Bo
B
Wen
Tian-fu
TF
Zhao
Ji-chun
JC
Yang
Jia-yin
JY
Wang
Wen-tao
WT
Xu
Ming-qing
MQ
Chen
Zhe-yu
ZY
Wu
Hong
H
Li
Jin
J
D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors; D055815:Young Adult