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Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation

Authors

  • Mutsumi Okazaki,

    1. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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  • Hirotaka Asato,

    1. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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  • Akihiko Takushima,

    1. Department of Plastic and Reconstructive Surgery, Kyorin University, School of Medicine, Mitaka-City, Tokyo, Japan
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  • Takashi Nakatsuka,

    1. Department of Plastic and Reconstructive Surgery, Saitama Medical School, Iruma-gun, Saitama, Japan
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  • Shunji Sarukawa,

    1. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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  • Keita Inoue,

    1. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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  • Kiyonori Harii,

    1. Department of Plastic and Reconstructive Surgery, Kyorin University, School of Medicine, Mitaka-City, Tokyo, Japan
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  • Yasuhiko Sugawara,

    Corresponding author
    1. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
    • Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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    • Telephone: 81-3-3815-5411; FAX: 81-3-5684-3989

  • Masatoshi Makuuchi

    1. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abstract

In living-donor liver transplantation (LDLT), reconstruction of the hepatic artery is challenging because the recipient artery is located deep in the abdominal cavity and the operating field is limited. Also, the hepatic artery of the graft is short and the recipient artery is occasionally damaged. To overcome these difficulties, we developed a double-needle microsuture technique for artery reconstruction. A total of 161 adult patients received 163 LDLTs using this new technique. The first suture was placed at the most difficult point in the artery to be visualized through the microscope. Each stitch was placed from the inner side of the arterial wall to the outer side. The posterior stitch was tied pulling toward the back. The subsequent sutures were advanced anteriorly on either side adjacent to the previous suture. Hepatic artery thrombosis occurred in 4 patients (2.5%), only 2 (1.2%) of which were associated with arterial reconstruction. Intimal dissection developed in the recipient artery in 2 patients (1.2%). Three (50%) of these 6 complications occurred more than 10 days after LDLT. In conclusion, this suturing technique allows for safe intimal adaptation even when the arterial tunica intima is separated from the tunica media, because all stitches are carried from inside of the vessel to the outside, contributing to more satisfactory results. Liver Transpl 12:46–50, 2006. © 2005 AASLD.

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