Pure Laparoscopic Donor Right Hepatectomy (PLDRH) - Maneuvers to Achieve Adequate Exposure with Technical Tips and Tricks

Abstract

Pure Laparoscopic Donor Right Hepatectomy is a technically challenging surgery requiring long hours of focussed team effort. Access and mobilisation:•Placement of camera ports as high as possible in the line of hilum, right subcostal region•Goldfinger/Snake Liver Retractor 5mm via epigastric port for adequate right lobe liver retraction•Use of endoloop for traction of Gall bladder and divided end of falciform ligament. Hilar dissection:•Gold finger passed anterior to the cava and brought out in the space created between the right hepatic vein and middle hepatic vein in the suprahepatic space.•Umbilical tape passed in the space created by the gold finger which helps achieve hanging, useful for parenchymal transection .•ICG guided Liver parenchymal surface marking for accurate parenchymal transection Parenchymal transection:•Use of rubber band traction for sustained and firm liver traction.•Use of CUSA excel (CUSA with monopolar cautery in the same device) for adequate hemostasis while parenchymal transection•Gold finger is used to encircle the entire right portal pedicle, and umbilical tape is brought in this space which helps in completing the remaining parenchymal transection by hanging manoeuvre. Organ procurement via pfannensteil incision:•Right hepatic duct is encircled with hilar sheath using ICG guidance and divided with scissors sharply after placing a clip to the right hepatic duct orifice.•Right hepatic artery clipped, right portal vein stapled and divided while the right hepatic vein and IVC ligament is divided using a stapler.