Effective and Safe Living Donor Hepatectomy Under Intermittent Inflow Occlusion and Outflow Pressure Control

  • Toru IkegamiEmail author
  • Tomoharu Yoshizumi
  • Yuji Soejima
  • Masaki Mori
Letter to the Editor

We read the article provided by Sultan et al.1 showing better performance in harmonic scalpel, with statistically significant shorter operative time (360 min vs. 440 min, p < 0.01) statistically non-significant but smaller amount of blood loss (300 ml vs. 500 ml, p = 0.11), and similar grade III complication rate (11.1% vs. 16.7%, p = 0.49) compared with clamp-crush technique for living donor hepatectomy (LDH). Contradictory to the results, they concluded clamp-crush technique as a simple, easy, safe, and cheaper method for LDH. It is true that clamp-crush is cheaper as the authors concluded. However, simplicity, easiness, or proficiency in surgical processes should be associated with operative time and blood loss, and safety with complications. We are concerned about the inconsistency between the actual results and the conclusion with preference in clamp-crush technique.

Moreover, we regret possible rooms for improving their surgical outcomes regardless of the instruments used for...


Living donor liver transplantation Living donor hepatectomy Pringle’s maneuver Vena cava clamping 



Living donor hepatectomy



  1. 1.
    Sultan AM, Shehta A, Salah T, Elshoubary M, Elghawalby AN, Said R, et al. Clamp-crush technique versus harmonic scalpel for hepatic parenchymal transection in living donor hepatectomy: a randomized controlled trial. J Gastrointest Surg 2019 doi: [Epub ahead of print]
  2. 2.
    Ikegami T, Shirabe K, Yamashita Y, Yoshizumi T, Harimoto N, Takeishi K, et al. Small upper midline incision for living donor hemi-liver graft procurement in adults. J Am Coll Surg 2014;219:e39–43CrossRefGoogle Scholar
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    .Ikegami T, Harimoto N, Shimokawa M, Yoshizumi T, Uchiyama H, Itoh S, et al. The learning curves in living donor hemiliver graft procurement using small upper midline incision. Clin Transpl 2016;30:1532–1537.CrossRefGoogle Scholar
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    Imamura H, Takayama T, Sugawara Y, Kokudo N, Aoki T, Kaneko J, et al. Pringle’s manoeuvre in living donors. Lancet 2003;361:788.CrossRefGoogle Scholar
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    Ueno M, Kawai M, Hayami S, Hirono S, Okada KI, Uchiyama K, et al. Partial clamping of the infrahepatic inferior vena cava for blood loss reduction during anatomic liver resection: A prospective, randomized, controlled trial. Surgery 2017;161:1502–1513.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

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