Technique of left lateral in situ splitting

Splitting livers: Trans‐hilar or trans‐umbilical division? Technical aspects and comparative outcomes

“…Overall, the results in both groups were excellent; they compare very well in terms of complication rates and outcomes with other series in the literature; in fact, with the overall actual graft and patient survival being 96% and 98%, respectively, the rates are above of those usually reported with these graft types (<85% in most large series [17,30]); this strengthens this technical analysis and the relevance of the conclusions. Although the graft survival rate is reaching a statistically significant difference between type A and type B, this may not be directly related to the technique itself.…”

“…This potentially seriously compromises the vitality of that segment, and its fate has been well described in previous reports in the following terms: a need for a secondary segmentectomy (13); 22% of the cases were with related complications within the first month including two related deaths (34); and 66% of the cases with signs of Segment IV hypoperfusion at a computerized scan (35). With these facts, and the lack of anatomical evidence to the contrary, the concept of augmenting the mass of a right split liver graft, by retaining Segment IV ("extended" right split graft [17,30]), and justifying the retaining of Segment IV with the right side, is difficult to support. 5 On the contrary, retaining part of the Segment IV mass within the LSG can successfully help enlarging the graft when the LLS is rather small in size; simply by shifting the line of division to the right, through Segment IV (TH) and creating a Segment II-III-IV LSG, allows for procuring more mass for the graft, with no changes in the surgical approach (12, 14, 15) ( Fig.…”

“…After the preparation of the extrahepatic structures, the peritoneum of the umbilical fissure is opened from the umbilical ligament to the porta hepatis, exposing the Rex recessus (the distal portion of the left portal vein running between Segment IV and the LLS) (Figs. 1 and 2) (13)(14)(15)(16)(17)(18)(19)(20). All branches of the Rex recessus vein, draining into Segment IV, are divided, and the Rex vein is shifted to the left to expose the umbilical plate, where the division will take place later.…”

Optimal line of hepatotomy for left lateral living donor liver transplantation according to the anatomical variations of left hepatic duct system

“…As discussed before, the ideal situation for an LLS LDLT would be to end up with needing as few recipient anastomoses as possible, ideally one. The standard technique of a LDLT usually involves dividing the liver just at the FL . It would seem, then, that with this technique, the only chance of needing a single recipient anastomosis would be if the donor liver had a Type I variation.…”