Orthotopic Liver Transplantation in the wrath is a demanding procedure and requires a lung microsurgical training to be mastered properly. Accuracy and speed, especially during the phase of implantation are the keys to success. In the next videos, we will reveal every fundamental step to a successful transplantation and explain how a quick clinical device can facilitate the implantation phase.
Enjoy the videos. The donor is open via transverse incision. The falciform ligament is section and the inferior satic vena cava is exposed.
Left diaphragmatic vein is detached from the cava, then divided between silk seven oh ties. Gas osteopathic ligament is sectioned, then esophageal ligament is divided between ties. The atic vena cava is exposed by gently pulling small en large bowel.
On the left side, peritoneum is opened and the vena cava is gently freed from the surrounding tissues. The right adrenal vein is isolated and then divided between seven oh ties. Liver is pulled on the left side and gently kept under traction.
Retro hepatic and right triangular ligaments are sectioned.Right. Renal vein is tied at its proximal end using a 10 oh nylon tie. Right renal vein and artery are tied together at their distal end right renal vein is then divided.
Overview of the completely isolated repath vena cava is shown. Overview of the hepatic hilum and postal vein regional anatomy, proper hepatic artery, common B duct gastro splenic vein. The pancreas glu.
The gastro splenic vein is isolated and divided between a 10 oh and a seven oh tie. Upper hepatic artery is sectioned between seven oh ties. Finally, the vino pancreatic vein is divided.
An overview of the isolated vena porter is shown. Common bile duct is partially opened at its junction with the pancreatic tissue. A 3.5 millimeter 22 G stent is inserted and strongly secured.
10 units of heparin are injected. Liver is then flashed through the vena porter with 20 milliliter of colder ized ringer lactate solution while distal vena cava is incised to allow an adequate outflow, the vena porter is cut at its distal end section of the common bowel duct is completed. F hepatic vena cava is then cut at its distal end while supra hepatic vena cava is cut, skied to the diaphragm that is removed and immersed into a four degrees Celsius Wrangler lactate solution solution.
Vena porter is inserted into its calf, then diverted to expose the intima and finally secured on the calf with a seven oh tie. The same is done on the repath vena calf. A micro clamp is positioned on the very cranial part of the repath vena cava.
Liver is overturned and two ATO prolene stitches are passed at the opposite lateral edges of the satic Vena cava from outside to inside Recipient is Kept under Isof. Fluor anesthesia on a warm pad, 10 milliliters. Normal cell line are injected subcutaneously before laparotomy em midline cyop pubic incision is performed and cy is retroverted in order to better expose the liver.
Common bi Duct is secured with a seven oh tie and sectioned just before its bifurcation left and right. Portal branches are accurately separated. Caval ring is positioned around the vena cava cranial to the left renal vein.
A first nine oh stitch is passed through the vessel wall at its right edge, then secured to the caval ring in the pre-established position. A second stitch is passed through the opposite edge and secured. The third one is secured in ventral position.
Finally, the fourth one is secured in dorsal position. After having overturned the ring on the left side, the first stitch is passed through the posterior wall by lifting the vessel. The portal ring is then positioned and the tie is secured to its posterior branch.
A second stitch is passed through the edge of the left portal branch and secured third one to the edge of the right portal. Branch Then secured. The last one pierces the anterior wall of the port And is secured in position Before clamping.
A last cleaning of the satic vena cava is performed in repath Vena cava and vena porta are cross clamped in order. Spath vena cava is then Cross clamped and incised scheme to the parenchyma Left and right portal branches are cut and the septum in between is divided inre vena cava is cut scheme to the parenchyma. Then liver is removed.
Inna cava and vena porta are safely kept opened by the two rings. Graft is positioned into the abdominal cavity and the NATO suture is secured to the left edge of the spath vena cava. A second suture is secured to the right edge.
Iranian suture of the posterior wall is performed from left to right, therefore not to include the liver parenchyma into the suture. The anterior wall suture is kept loose in order to allow a generous flashing before complete closure. This maneuver avoids air embolism.
The coddle branch of the approximator is inserted into the portal ring handle and the portal calf is inserted through the slit of its cranial branch. The recipient's Vina porter is flashed with normal saline while the approximator is closed. To assist the calf insertion recipient's, Porter is secured to the calf by a seven oh tie.
The Approximator is removed and portal flow reestablished by removing in order the Atic VNA CVA clamp and the portal clamp portal ring is removed by cutting. The nano ligatures though is reestablished with the same technique recipients. Common bile duct is kept under traction and the stent is inserted through a small incision.
A circular ligature secures its position. An overview of the fused graft is shown a.
