Abstract
Background
In literature, a variety of caval reconstruction techniques for liver transplantation have been reported. The piggyback technique preserves the recipient’s caval vein which is directly anastomosed to donor’s inferior vena cava (IVC) allowing for the reduction of hemodynamic compromise during liver transplantation.
Methods
Herein, we present our standardized step-by-step technique for the realization of a caval one-shot side-to-side anastomosis (OSSSA) using a linear stapler. A Satinsky vascular clamp is placed in a top down direction to realize a longitudinal partial clamping of the recipient IVC. A 1-cm venotomy is then performed on the anterior wall of the recipient IVC to permit the easy introduction of the vascular stapler arm in order to perform the mechanical anastomosis. Portal vein, hepatic artery, and biliary anastomosis are then completed in standard fashion.
Conclusions
Compared to the manual one, this mechanical anastomosis permits to reduce operative time, caval and portal vein clamping, warm ischemia time, and visceral congestion.
Results
In our opinion, this is a rapid, easy, safe, and reproducible technique to perform the side-to-side cavocaval anastomosis during liver transplantation in selected patients when a manual anastomosis may be technically challenging.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR (1963) Homotransplantation of the liver in humans. Surg Gynecol Obstet 117:659–676
Navarro F, Moine M-CL, Fabre J-M et al (1999) Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: review of 1361 cases. Transplantation 68(5):646–650
Calne RY, Williams R (1968) Liver transplantation in man–I, observations on technique and organization in five cases. BMJ 4(5630):535–540
Tzakis A, Todo S, Starzl TE (1989) Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg 210(5):649–652
Belghiti J, Sauvanet A, Panis Y, Gayet B, Fékété F (1992) Liver transplantation without clamping of the inferior vena cava. Presse Medicale Paris Fr 1983 21(12):569–571
Quintini C, Miller CM, Hashimoto K et al (2009) Side-to-side cavocavostomy with an endovascular stapler: rescue technique for severe hepatic vein and/or inferior vena cava outflow obstruction after liver transplantation using the piggyback technique. Liver Transpl 15(1):49–53
Akbulut S, Wojcicki M, Kayaalp C, Yilmaz S (2013) Liver transplantation with piggyback anastomosis using a linear stapler: a case report. Transplant Proc 45(3):1031–1033
Zeebregts CJ, Kirsch WM, Reijnen MMPJ, Zhu YH, van den Dungen JJAM (2005) Expanding use of nonpenetrating clips in various surgical specialities. Surg Technol Int 14:85–95
Calles-Vázquez MC, Abellán Rubio E, Crisóstomo Ayala V, Usón Gargallo J, Sánchez Margallo FM (2013) Growing cava vein anastomosis: comparison of cross-clamping and suture times using VCS metallic clips, interrupted nonabsorbable, or continuous absorbable suturing techniques. Ann Vasc Surg 27(7):947–953
Wang Y, Xin Z, Pan B et al (2017) Venous anastomosis using a non-penetrating vascular closure system in orthotopic liver transplantation. Clin Transplant 31(12):e13123
Liu C, Tsai H-L, Loong C-C, Hsia C-Y, Chin T, Wei C (2006) ENDO-GIA staplers for side-to-side anastomosis of veins. Eur J Vasc Endovasc Surg 32(5):584–588
Mehrabi A, Mood ZA, Fonouni H et al (2009) A single-center experience of 500 liver transplants using the modified piggyback technique by Belghiti: modified piggyback liver transplantation. Liver Transpl 15(5):466–474
Author information
Authors and Affiliations
Contributions
Antonio Cubisino: design, data manager, drafting, final approval. Piera Leon: design, data manager, drafting, final approval. Francis Navarro: design, data manager, drafting, final approval. Fabrizio Panaro: design, data manager, drafting, final approval.
Corresponding author
Ethics declarations
Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cubisino, A., Leon, P., Navarro, F. et al. One-shot side-to-side anastomosis (OSSSA) with stapler for cavo-cavostomy in liver transplantation: the first step towards a fully mechanized liver transplant?. Langenbecks Arch Surg 406, 1711–1715 (2021). https://doi.org/10.1007/s00423-021-02254-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-021-02254-1