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. 1985 Nov;5(4):349-56.
doi: 10.1055/s-2008-1040632.

Refinements in the surgical technique of liver transplantation

T E Starzl, S Iwatsuki, C O Esquivel, S Todo, I Kam, S Lynch, R D Gordon, B W Shaw Jr

Refinements in the surgical technique of liver transplantation

T E Starzl et al. Semin Liver Dis. 1985 Nov.
No abstract available

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Figures

FIG. 1
FIG. 1. In situ infusion technique used when the kidneys and liver are removed from the same donor
R.g.a.: right gastric artery; G.d.a.: gastroduodenal artery; S.a.: splenic artery; S.v.: splenic vein; P.v.: portal vein; S.m.v.: superior mesenteric vein. (Reproduced with permission from Starzl et al.1)
FIG. 2
FIG. 2. Methods used to reconstruct a complex donor anomaly (1) split arterial supply to the liver originating from the left gastric artery (LGA), celiac axis (c.a.), and superior mesenteric artery (s.m.a.), (2) a patch of anterior aorta, including the origins of the celiac axis and superior mesenteric artery, is removed
The renal artery orifices are protected, (3) folding of the aortic patch permits safe anastomosis of the celiac axis to the superior mesenteric artery, (4) the superior mesenteric artery distal to the right hepatic artery is used for anastomosis to the recipient artery (recip.h.a.), (5) the reconstructed arterial supply of the graft may be rotated to match the orientation of the host vessel. s.a.: splenic artery; L.R.A.: left renal artery; R.R.A.: right renal artery; P.V.: portal vein; s.m.v.: superior mesenteric vein. (Reproduced with permission from Gordon et al.5)
FIG. 3
FIG. 3. Method of rapid liver cooling that can be done without any preliminary dissection except for insertion of a distal aortic cannula and cross-clamping of the aorta at the diaphragm
The infusion fluid quickly gets into the portal system via the splanchnic capillary bed, providing double inflow cooling. G.B.: gallbladder; i.a.a.: inferior mesenteric artery; see Figure 2 for other abbreviations. (Reproduced with permission from Starzl et al.7)
FIG. 4
FIG. 4. Pump-driven bypass
(Reproduced with permission from Griffith et al.11)
FIG. 5
FIG. 5. Operative field after retrograde liver mobilization
The last-remaining structure, the suprahepatic inferior vena cava (I.v.c.), has been clamped above the liver. Inset: Technique for mobilization of a suitable length of suprahepatic vena cava after placement of clamp. In adults, this usually involves cutting away cirrhotic liver tissue over the frequently distorted and fore-shortened right and left hepatic veins. (Reproduced with permission from Starzl et al.13)
FIG. 6
FIG. 6. 1, 2: Elimination of raw surfaces in the right bare area with continuous sutures
3, 4: Similar treatment of the left triangular and falciform ligaments, eliminating all raw surfaces. 5: Closure of bare area in the bed of the excised retrohepatic inferior vena cava. Failure to obtain good initial hemostasis from this region can lead to the loss of liters of blood during and after the actual transplantation. (Reproduced with permission from Starzl et al.14)
FIG. 7
FIG. 7. Method of avoiding strictures of small vascular anastomoses
See text for explanation. (Reproduced with permission from Starzl et al.17)
FIG. 8
FIG. 8. Methods of biliary tract reconstruction that have been used with liver transplantation
The techniques shown in E and F are so defective that they have been abandoned. Depending on the anatomic and clinical circumstances, each of the other methods may be useful in individual cases. (Reproduced with permission from Starzl et al.19)
See this image and copyright information in PMC

References

    1. Starzl TE, Hakala TR, Shaw BW, Jr, et al. A flexible procedure for multiple cadaveric organ procurement. Surg Gynecol Obstet. 1984;158:223–230. - PMC - PubMed
    1. Starzl TE, Iwatsuki S, Shaw BW, Jr, et al. Pancreaticoduodenal transplantation in humans. Surg Gynecol Obstet. 1984;159:265–272. - PMC - PubMed
    1. Shaw BW, Jr, Hakala TR, Rosenthal TR, et al. Combination donor hepatectomy and nephrectomy and early functional results of allografts. Surg Gynecol Obstet. 1982;155:321–325. - PMC - PubMed
    1. Starzl TE. Experience in Hepatic Transplantation. Philadelphia: W.B. Saunders Company; 1969. (with the assistance of Putnam CW)
    1. Gordon RD, Shaw BW, Jr, Iwatsuki S, et al. A simplified technique for revascularization of liver homografts with a variant right hepatic artery from the superior mesenteric artery. Surg Gynecol Obstet. 1985;160:474–476. - PMC - PubMed

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