Split-Liver Full-Left Full-Right: Proposal for an Operative Protocol

Ferla, Fabio; Lauterio, Andrea; Sandro, Stefano Di; Mangoni, I.; Poli, Caroline; Concone, Giacomo; Cusumano, Caterina; Giacomoni, Alessandro; Andorno, Enzo; Luciano, Laure

doi:10.1016/j.transproceed.2014.07.066

Cited by 15 publications

(15 citation statements)

References 13 publications

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“…mortality, and at the same time to avoid discarding the right side of the liver [1][2][3]5]. Since, there has been a general agreement on anatomic classifi cation made by Couinaud and accept across Asian, European and North American Transplant communities [6,7].…”

Section: Resultsmentioning

confidence: 99%

“…Infants have the highest wait-list mortality of all liver transplantation candidates [5,6]. Deceased donor split-liver transplantation, a technique that provides both an adult and pediatric graft, might be the best way to decrease this disproportionate mortality [4,6].…”

Section: Types Of Splitmentioning

confidence: 99%

“…The main advantages of the IS technique are that ischemia time is shorter and that optimal control of bleeding from the cut surface of both grafts may be performed during the splitting procedure itself, so that minimal bleeding is expected after implantation in the recipient [ 1,[3][4][5]11]. On the other hand, the IS technique signifi cantly increases the operation time on the donor, thus impacting the organization of the procedure both for the donor hospital and for the teams involved in procuring other organs [1,3,4].…”

Section: Types Of Splitmentioning

confidence: 99%

“…Favorable liver graft allocation policies and collaborative coordination among centers represent the basis for a rational, extensive use of this donor source [5,12,13]. In our donors we had used area transportation by the large distance, we had a directly communication with the coordination and the Hospital (Pediatric Hospital CMNSXXI, IMSS).…”

Section: Logistical Considerationmentioning

confidence: 99%

“…This generates a graft for a small child and an adult or bigger child, respectively or bigger child respectively. And in the split for two adults, this would entail transection of the liver near the main lobar fi ssure to generate two hemi liver grafts [3,5,7,11].…”

Section: Split Liver Proceduresmentioning

confidence: 99%

See 4 more Smart Citations

Split/Reduced Liver Transplantation “IMSS”: The First Two Cases and Literature Overview

Aurelus¹,

Yáñez²,

Nagano³

et al. 2017

Arch Organ Transplant

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Section: Resultsmentioning

confidence: 99%

Section: Types Of Splitmentioning

confidence: 99%

Section: Types Of Splitmentioning

confidence: 99%

Section: Logistical Considerationmentioning

confidence: 99%

Section: Split Liver Proceduresmentioning

confidence: 99%

See 3 more Smart Citations

Split/Reduced Liver Transplantation “IMSS”: The First Two Cases and Literature Overview

Aurelus¹,

Yáñez²,

Nagano³

et al. 2017

Arch Organ Transplant

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Solid organ transplantation—where we are and how far can we possibly go?

Froněk

2016

Eur Surg

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Split liver technique with middle hepatic vein reconstruction on livers from transplant hepatectomies: a useful tool for surgical improvement

Sguinzi¹,

Ferla

Carlis

et al. 2018

Updates Surg

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Livers removed during transplant hepatectomies could represent a useful anatomic ex vivo resource for surgical training, since they are intact and not altered by post-mortem changes yet. The aim of this study is to investigate the effectiveness of such kind of surgical training applied on some hepatic surgery techniques. In the present paper, we focused on split liver operation and middle hepatic vein (MHV) bipartition/reconstruction, since these procedures have a quite long learning curve. Seven native livers were submitted to split liver procedure by a senior resident assisted by a fully trained hepatic surgeon. Pre-splitting ultrasound mapping was compared to pre-operative CT scan. The whole graft was divided into two hemi-livers and the MHV into two hemi-confluents and reconstructed by venous or arterial patches obtained by deceased donor iliac homograft. Water tightness of the anastomosis was confirmed by hydro-pneumatic test and bench portal perfusion. Reduction in operating time was considered an indirect indicator of surgical skill improvement. In all cases, the US confirmed the anatomical distribution of MHV tributaries observed by pre-transplant CT scan. The "ex situ" splitting procedures and MHV bipartition and reconstruction were performed in all native livers in the usual time required for liver transplantation bench surgery (range 50-75 min). Liver grafts removed during hepatectomy could represent a useful resource of intact organs to perform surgical training and boost surgical confidence. In our initial experience, the study of venous drainage of the MHV and application of liver splitting technique and MHV reconstruction resulted technically feasible.

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Split-Liver Full-Left Full-Right: Proposal for an Operative Protocol

Cited by 15 publications

References 13 publications

Split/Reduced Liver Transplantation “IMSS”: The First Two Cases and Literature Overview

Split/Reduced Liver Transplantation “IMSS”: The First Two Cases and Literature Overview

Solid organ transplantation—where we are and how far can we possibly go?

Split liver technique with middle hepatic vein reconstruction on livers from transplant hepatectomies: a useful tool for surgical improvement

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