Editing Donor hepatectomy

* Supine, both arms tucked
* Drape chest, abdomen, proximal thighs
* Midline incision from suprasternal notch or xiphoid process to pubis
* Balfour to expose abdomen +/- sternal retractors if chest is opened
* Explore for contraindications to explant, and evaluate liver (size and parenchymal quality)
** Look for sharp edges, smooth surface with appearance of scratching marks, and brownish surface colour
* Abdominal dissection
** Divide round ligament between two heavy silk ties
** Take down falciform ligament to confluence of hepatic vein/suprahepatic vena cava
** Divide left coronary and triangular ligaments
** Reflect left lateral sements (II and III) towards donors right side to access gastrohepatic ligament (inspect this carefully for a replaced or accessory left hepatic artery - 10% of donors - if present, divide ligament above and below the artery)
* Retroperitoneal dissection
** Reflect ascending colon medially
** Ascending colon and D2 are mobilised and reflected to the left
** Mobilise remaining small intestine cephalad until left renal vein is visible (look out for SMA, left renal artery and pancreas)
** Isolate IMV at ligament of Treitz. This is distally ligated then canulated for precool perfusion
** Expose distal abdominal aorta above level of the bifurcation for canulation and clamping
* Reflect small intestine and ascending colon into abdomen to expose porta hepatis
* Tie off CBD distally with 2-0 silk and half-way incised just above the tie, then wash out via a transcystic flush until the effluent is clear
* Expose supracoeliac aorta, and encircle with umbilical tape
* Systemically heparinize with 300-500 IU/kg for 3 minutes
* Ligate aorta at bifurcation and insert cardiac catheter. Cross-clamp supracoeliac.Transect suprahepatic vena cava at caval-atrial junction. Liver can be covered with ice.


[[Category:HPB]]