title: The "carving" liver partitioning technique for graft hepatectomy in live donor liver transplantation: a single-center experience.
abstract: BACKGROUND
  In adult live donor liver transplantation, postoperative venous congestion of graft and remnant livers can lead to life-threatening complications. The purpose of this study was to evaluate the safety and benefits of our 3-dimensional, computed tomographic, computer-assisted donor hepatectomy using the "carving" partitioning technique.
  
  
  METHODS
  Eighty-three consecutive adult live donor liver transplantations were performed based on data obtained from individualized preoperative 3-dimensional, computed tomographic reconstructions and virtual graft hepatectomies.
  
  
  RESULTS
  There were 71 right and 12 left grafts. Small grafts (graft volume body weight ratio, <1.0) were used in 20 cases. We observed no clinically important differences in postoperative function between right and left grafts. Four recipients developed lethal small-for-size syndrome. Reversible small-for-size syndrome was observed in a right graft recipient and in 2 right graft donors.
  
  
  CONCLUSIONS
  Preoperative 3-dimensional, computed tomographic, computer-assisted planning using virtual liver partitioning allowed for: (1) an individualized carving technique based on specific donor anatomic characteristics, (2) donor safety based on individualized patterns of venous outflow, and (3) optimized drainage of the medial area of the graft based on the preferential inclusion of the middle hepatic vein.
authors.affiliation: Department of General, Thoracic, and Transplant Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
authors.forename: Vito R
authors.initials: VR
authors.lastname: Cicinnati
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Heinz-Otto
authors.initials: HO
authors.lastname: Peitgen
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
mesh_terms: D000328:Adult; D003198:Computer Simulation; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome