title: A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique.
abstract: OBJECTIVE
  Hepatic artery anastomosis (HAA) is the most important aspect of living donor liver transplantation (LDLT), and it is currently performed by a specialized microsurgeon using micro surgical techniques, with interrupted sutures and the aid of an operative microscope. To simplify the procedure, we studied a new, simpler technique performed by pediatric transplant surgeons with continuous sutures and the same 3.5× magnification loupe used during other transplant procedures. The aim of this study was to compare these two hepatic artery reconstruction techniques in two pediatric LDLT series.
  
  
  METHODS
  This study was initiated in January 2010 and finished in June 2013. In the first period, the arterial reconstruction was performed with an operating microscope and the classical technique of 9-0 separate sutures. In the second period, the arterial reconstruction was performed using a simpler technique, with surgical loupe and continuous 8-0 Prolene sutures. The incidences and outcomes of complications within the two periods were analyzed and compared.
  
  
  RESULTS
  A total of 82 LDLTs were performed, 38 in the first period and 44 in the second period. There were no differences between the periods, except for the arterial ischemia time, which was lower in the second period.
  
  
  CONCLUSIONS
  Hepatic artery anastomosis can be safely performed with low complication rates by a pediatric transplant surgeon using continuous sutures with a 3.5× magnifying loupe. This technique is simpler, less time consuming and simplifies the complex pediatric LDLT procedure.
authors.affiliation: Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao, Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Ana Cristina Aoun
authors.initials: AC
authors.lastname: Tannuri
authors.affiliation: Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao, Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Roberta Figueiredo
authors.initials: RF
authors.lastname: Monteiro
authors.affiliation: Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao, Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Maria Mercês
authors.initials: MM
authors.lastname: Santos
authors.affiliation: Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao, Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Helena Thie
authors.initials: HT
authors.lastname: Miyatani
authors.affiliation: Division of Pediatric Surgery and Liver Transplantation Unit, University of Sao, Paulo Medical School, Sao Paulo, Brazil. Electronic address: uenist@usp.br.
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
mesh_terms: D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D013536:Suture Techniques / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Complications of liver transplantation; Donor hepatectomy; Hepatic artery anastomosis; Living-donor liver transplantation; Pediatric liver transplantation