Liver transplant
Living donor right hepatectomy with a segment 6/7 and segment 8 veins and 2 ducts
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Case Scenario
- The living donor was a 48 year old woman.
- A previous cholecystectomy had been performed.
- The transection plane extends from the junction of the right hepatic vein with the cava and extends through the gall bladder fossa to the pre-determined location of bile duct transection.
- Intraoperative cholangiogram will confirm the bile duct transection location.
- The right lobe graft will consist of segments V, VI, VII and VIII. Pre-op calculations estimated a volume of 812 cm³.
- The remaining left lobe volume of 326 cm³ was calculated to be safe for the donor.
- Two bile duct branches, 6/7 and 5/8 branches of the right hepatic duct, were transected, yielding a graft with two bile duct orifices.
- The bile ducts were cut to leave good tissue for re-implantation. If the tissue is too thin, it will be difficult to sew, and may result in leakage.
- The donor bile duct orifices were sutured closed with running 6-0 PDS suture, in such a manner as not to compromise the lumen for the common bile duct.
- In addition to the right hepatic vein, significant segment 6/7 and segment 8 hepatic vein branches were preserved for the donor graft.
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