title: Optimal line of hepatotomy for left lateral living donor liver transplantation according to the anatomical variations of left hepatic duct system.
abstract: Multiple duct anastomoses during LLS transplantation increase the incidence of biliary complications. The optimal plane of hepatotomy that results in the least number of bile ducts at the surface was investigated according to LHD variations. Ducts of 30 human livers were injected with resin and LHD branching on 3D-CT reconstructions were analyzed. Ducts on the virtual hepatotomy surface were estimated in three splitting lines. Variations with subtypes were described. Ia (66.7%): ducts from segments (S.) II-III form a common trunk and S.IV duct joins it. Ib (10%): common trunk formed by ducts from S.II-S.III while S.IV duct joins the common hepatic duct. IIa (16.67%): S.IV duct drains into S.III duct. IIc (3.33%): S.IV duct drains into both S.II and S.III ducts. III (3.33%): trifurcation of S.II, S.III and S.IV ducts. When the virtual hepatotomy line was on the FL, there was a single duct for the anastomosis in 30% of cases but two, three, or four ducts in 53.3%, 10%, and 3.3%, respectively. Division 1 cm to the right of the FL resulted in one duct (70%), but S.IV duct injury may occur. LLS hepatotomy should not necessarily be performed along the FL. Variations must be taken into consideration to minimize the number of biliary anastomoses during liver implantation.
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Mátyás
authors.initials: M
authors.lastname: Kiss
authors.affiliation: Department of Hepatobiliary Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Rahul R
authors.initials: RR
authors.lastname: Deshpande
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Ágnes
authors.initials: Á
authors.lastname: Nemeskéri
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Tien T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kürti
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Sándor
authors.initials: S
authors.lastname: Kovács
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Pápai
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Károly
authors.initials: K
authors.lastname: Németh
authors.affiliation: Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Szuák
authors.affiliation: Department of Radiology and Oncotherapy, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Ibolyka
authors.initials: I
authors.lastname: Dudás
authors.affiliation: Department of Transplantation and Surgery, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Kóbori
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001344:Autopsy; D001652:Bile Ducts / Q000033:anatomy & histology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D002758:Cholangiography / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006500:Hepatic Duct, Common / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D010179:Pancreas / Q000033:anatomy & histology; D014057:Tomography, X-Ray Computed
keywords: anatomical variations; left hepatic duct; left lateral segment transplantation; living donor liver transplantation