Abstract
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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Abbreviations
- MHV:
-
Middle hepatic vein
- US:
-
Ultra-sound
- CT:
-
Computed tomography
- HCC:
-
Hepatocellular carcinoma
- IVC:
-
Inferior vena cava
- SLP:
-
Split liver procedure
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Acknowledgements
Our surgical anatomic study was performed on livers removed during hepatectomy during liver transplantation. All organs were submitted to pathological examination for definitive diagnosis of underlying disease. We give acknowledgment for the contribution to medical research to those who donated their bodies and their families for liver transplantations.
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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.
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Informed consent was obtained from all individual participants included in the study.
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Sguinzi, R., Ferla, F., De Carlis, R. et al. Split liver technique with middle hepatic vein reconstruction on livers from transplant hepatectomies: a useful tool for surgical improvement. Updates Surg 70, 491–494 (2018). https://doi.org/10.1007/s13304-018-0512-x
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DOI: https://doi.org/10.1007/s13304-018-0512-x