Korean J Transplant.  2023 Nov;37(Suppl 1):S85. 10.4285/ATW2023.F-6680.

Successful laparoscopic living donor right hepatectomy in a case with challenging portal vein variation

• Choi HH
• Lee KW

• KMID: 2551672
• DOI: http://doi.org/10.4285/ATW2023.F-6680

Abstract

Background
Type 3 refers to cases where the right posterior portal vein serves as the first branch of the main portal vein. In the presence of this anatomical variation, laparoscopic living donor right hepatectomy becomes a challenging surgical technique. Furthermore, the acute angle between the main portal vein and the left portal vein poses a high risk of postoperative portal vein complications. In this video, we demonstrate the technique to overcome these challenges.
Methods
The donors main portal vein and right hepatic artery were clamped with bulldogs, and the midplane of the liver was identified. Adequate dissection of the liver parenchyma was performed, followed by the division of the right bile duct and hilar plate. After resecting the right hepatic artery, the right anterior portal vein and the right posterior portal vein were separately divided. Subsequently, quilt venoplasty was performed using a cryopreserved iliac artery patch to create a single right portal vein during the bench operation.
Results
Laparoscopic living donor right hepatectomy was successfully performed without the need for open conversion, even in a challenging case with anatomically difficult portal vein variation. Postoperatively, Doppler sonography revealed a monophasic flow pattern and normal flow direction in the remnant left portal vein, and the donor’s recovery was excellent.
Conclusions
Laparoscopic living donor right hepatectomy of portal veins with challenging anatomical variations is a feasible and safe technique with meticulous planning and precise execution.