Variations Of Ducts Research Articles

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented. Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy. KEY WORDS: Cystic Duct, Hepatic Duct, Variation, MRCP.

Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population.

This study aimed to establish three-dimensional models of the biliary tract of Chinese people using the Hisense computer-aided surgery (CAS) system and to explore the branching patterns and variation types of the biliary system under the study of 3D reconstruction of the biliary tract. Three-dimensional models of the biliary tract were reconstructed in 50 patients using the Hisense CAS system. The branching patterns of intrahepatic bile ducts were observed. The biliary tract was classified according to the confluence of the right posterior sectoral duct (RPSD), right anterior sectoral duct (RASD) and left hepatic duct (LHD), and the presence or absence of accessory hepatic ducts. The 3D models of the bile ducts were successfully reconstructed in 50 Chinese patients. The branching patterns of the bile ducts were classified into seven types. The anatomy of the bile ducts was typical in 54% of cases (n = 27), showed triple confluence in 10% (n = 5), and crossover anomaly in 14% (n = 7), which means anomalous drainage of the RPSD into the LHD, anomalous drainage of the RPSD into the common hepatic duct (CHD) in 10% (n = 5), anomalous drainage of the RPSD into the cystic duct (CD) in 2% (n = 1), absence of left main hepatic duct in 1% (n = 1), presence of accessory duct in 8% (n = 4). Among them, there were three cases of accessory hepatic ducts coexisting with other variation types. By using the Hisense CAS system to establish 3D models of the biliary tract of the Chinese people, we established the branching model of the second-order bile ducts, which has important value for the classification of the biliary system and its variation types.

Extrahepatic Biliary Tract Variations is an Effect for Acute Calculous Cholecystitis.

To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC). Case-control study. Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021. The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test. One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values ​​were 30.5 mm, 36.5 mm, and 42.5 mm. Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples. Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.

All that Glitters is not Gold — Lateral Cervical Dermoid Cyst — Thyroglossal Duct Variant

All that Glitters is not Gold — Lateral Cervical Dermoid Cyst — Thyroglossal Duct Variant

The Statistical Characteristics of Atmospheric Ducts Observed Over Stations in Different Regions of American Mainland Based on High-Resolution GPS Radiosonde Soundings

Atmospheric duct is an anomalous atmospheric structure that affects electromagnetic wave propagation. The important characteristics of the atmospheric ducts include duct probability, duct height, duct strength, and the thickness of the trapping layer. To investigate the statistical characteristics of atmospheric ducts over the American mainland, four stations in different regions are chosen. The seasonal and diurnal variation of the characteristics of ducts is presented. The mechanism of the seasonal and variation of ducts is revealed and the relationship between the characteristics is researched. The duct strength correlates positively with the thickness of the trapping layer, and the duct height correlates with them negatively. Moreover, the duct relationship with precipitation over different stations is clarified. It is found that the precipitation correlates positively with the probability of ducts caused by the vertical moisture gradient, and the relation is negative when the ducts are caused by temperature inversion. This work is of great value to the statistical characteristics of atmospheric ducts over the American mainland.

Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies.

This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p<0.001) and transition period (48.1% vs. 24.3%; p<0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p=0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p=0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p=0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p<0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p<0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p<0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p=0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.

Effectiveness and Clinical Value of Laparoscopic Cholecystectomy and Cholangiography in the Diagnosis of Biliary Calculi

ObjectiveTo investigate the effectiveness and clinical value of cholangiography in the diagnosis of bile duct stones in laparoscopic cholecystectomy.Methods200 patients who underwent laparoscopic cholecystectomy in our hospital from January 2017 to January 2019 were randomly divided into research group and control group, with 100 cases in each group. The research group underwent choledochotomy and exploration with the help of choledochoscope, while the control group underwent cholangiography to diagnose bile duct stones. The cure rate, residual stone rate, complication rate, intraoperative bleeding, hospital stay and patient satisfaction were compared between the two groups.Resultsin the control group, 9 cases were converted to laparotomy, 20 cases of common bile duct stones, 10 cases of bile duct injury and 6 cases of common bile duct variation. In the research group, there were 2 cases of conversion to laparotomy, 12 cases of common bile duct stones, 2 cases of bile duct injury and 4 cases of common bile duct variation. The cure rate of the researchgroup was higher than that of the control group, There was significant difference between the two groups (P < 0.05). The residual amount of stones in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The incidence of postoperative complications in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The patient satisfaction in the research group was higher than that in the control group, and there was significant difference between the two groups (P < 0.05). The intraoperative blood output of the research group was lower than that of the observation group, and there was significant difference between the two groups (P < 0.05).Conclusioncholangiography is an effective method for the diagnosis of bile duct stones in laparoscopic cholecystectomy. Clarifying the variation and anatomical structure of bile duct is helpful to improve the surgical cure rate, reduce the residual rate of postoperative stones and the incidence of complications, reduce the amount of intraoperative bleeding, shorten the hospital stay, and promote the postoperative rehabilitation of patients.

Optimal Intervention for Initial Treatment of Anastomotic Biliary Complications After Right Lobe Living Donor Liver Transplantation.

Background: This study evaluated endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) as interventions for patients with anastomotic biliary complications (ABC) after living donor liver transplantation (LDLT). Methods: Prospectively collected data of patients who were diagnosed with ABC after LDLT between January 2013 and June 2017 were retrospectively reviewed. Results: There were 57 patients who underwent LDLT with a right liver graft using duct-to-duct biliary reconstruction and experienced ABC. Among the patients with RAD involvement, there were no significant differences in the intervention success (p = 0.271) and patency rates (p = 0.267) between ERCP and PTBD. Similarly, among the patients with RPD involvement, there were no significant differences in the intervention success (p = 0.148) and patency rates (p = 0.754) between the two procedures. Graft bile duct variation (p = 0.013) and a large angle between the recipient and graft bile duct (R-G angle) (p = 0.012) significantly increased the likelihood of failure of ERCP in the RAD. When the R-G angle was greater than 47.5°, the likelihood of ERCP failure increased. Conclusion: We recommend PTBD when graft bile duct variation is presented in patients with RAD involvement and/or when the R-G angle is greater than 47.5°.

Biliary balloon dilator impaction in a non-dilated bile duct with anatomical variations: a case report

BackgroundWhile techniques for extracting large stones from dilated bile ducts are increasing, options for small stones impacted in non-dilated bile ducts are limited.Case presentationWe report the case of an impacted biliary balloon dilator in a choledocholithiasis patient with a non-dilated bile duct and multiple anatomical variations, including low insertion of the cystic duct. After unsuccessful attempts with a stone extraction basket and balloon, a biliary balloon dilator with a sharp catheter tip was advanced into the bile duct. The balloon could not be removed from the bile duct even when deflated. The duodenoscope fell back into the stomach, causing the shaft of the dilator to break near the ampulla. We then removed the broken tip with a snare, which caused the balloon sheath to separate from the shaft and remain in the bile duct. Finally, we removed the sheath with rat-tooth forceps, leading to successful extraction of the stone-and-balloon complex.ConclusionsThe exceedingly rare possibility of balloon impaction should be kept in mind when using biliary balloon dilators in non-dilated bile ducts.

Pathological, molecular, and clinical characteristics of cholangiocarcinoma: A comprehensive review.

Cholangiocarcinomas are a heterogeneous group of highly aggressive cancers that may arise anywhere within the biliary tree. There is a wide geographical variation with regards to its incidence, and risk-factor associations which may include liver fluke infection, primary sclerosing cholangitis, and hepatolithiasis amongst others. These tumours are classified into intrahepatic, perihilar and distal based on their anatomical location. Morphologically, intrahepatic cholangiocarcinomas are further sub-classified into small and large duct variants. Perihilar and distal cholangiocarcinomas are usually mucin-producing tubular adenocarcinomas. Cholangiocarcinomas develop through a multistep carcinogenesis and are preceded by dysplastic and in situ lesions. While clinical characteristics and management of these tumours have been extensively elucidated in literature, their ultra-structure and tumour biology remain relatively unknown. This review focuses on the current knowledge of pathological characteristics, molecular alterations of cholangiocarcinoma, and its precursor lesions (including biliary intraepithelial neoplasia, intraductal papillary neoplasms of the bile duct, intraductal tubulopapillary neoplasms and mucinous cystic neoplasm).

Magnetic Resonance Cholangiopancreatography Evaluation of Intrahepatic Biliary Tree Variants in Nepalese Population based on Yoshida classification

Introduction&#x0D; The meticulously arranged hierarchical structure of the biliary tree is pivotal for liver function. This biliary tree is divided into intra and extrahepatic components. The anatomic variations of the biliary tree are notoriously common with studies reporting variations in 20% to 55% of the population in different parts of the world. This may result in misdiagnosis and serious injury to the biliary system during surgical procedures. Thus, accurate knowledge of the biliary tree is essential for the interpretation of radiological examination and presurgical planning for hepatobiliary surgery such as laparoscopic cholecystectomy and liver transplant. Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive and safe modality for the accurate evaluation of the biliary tree.&#x0D; Materials and Methods&#x0D; It was a prospective cross-sectional study performed using a 1.5 Tesla MRI machine. The complete morphology of intrahepatic bile ducts was evaluated and categorized as per Yoshida classification and compared with past literature.&#x0D; Results&#x0D; A total of 76 patients were studied during the period out of which 24 (31.6%) were males and 52 (68.4%) were females. The normal morphology of intrahepatic ducts (Yoshida type I) was found only in 44 (57.9%) cases and the rest of the cases (42.1%) showed variant anatomy. Yoshida type II was the next most common morphology. The study also found no significant correlation between the sex of the patient and the morphological variant.&#x0D; Conclusion&#x0D; Morphological variation of intrahepatic biliary ducts is very common. MRCP is a non-invasive and reliable method for the evaluation of intrahepatic biliary anatomy and its variants.

Magnetic Resonance Cholangiopancreatography vs Endoscopy Retrograde Cholangiopancreatography for Detection of Anatomic Variants of the Pancreatic Duct in Children

To compare the efficacy of magnetic resonance cholangiopancreatography (MRCP) with endoscopy retrograde cholangiopancreatography (ERCP) in children for the identification of pancreatic duct variants. We identified children with a pancreatic duct variant by ERCP and separately queried our MRCP database for similar variants. Patients with a paired ERCP-MRCP were reviewed. Three radiologists blinded to the ERCP and MRCP findings were asked to independently review the MRCP studies and define the pancreatic duct anatomy. These blinded reviewers also graded the magnetic resonance imaging examination quality. Seventy-four pairs of ERCP-MRCP examinations were identified. Pancreas divisum was the most frequent ductal variant encountered (73%). There was fair agreement between the radiology reviewers as to the quality of the magnetic resonance imaging studies (Fleiss Kappa agreement). Concordance of the reviewers with that of the ERCP was moderate for the exact diagnosis, moderate for the presence of pancreas divisum, and fair for agreement on the presence of any duct variant. Concordance among reviewers was moderate for the exact diagnosis, moderate for normal vs abnormal, and substantial for the presence of pancreas divisum. Diagnostic limitations exist when comparing MRCP with the gold reference standard of ERCP, specifically when assessing for pancreatic duct variants in children.

Dejstvo i značaj varijacija anatomije ekstrahepatičnih žučnih kanala u etiologiji holedoholitiaze

Background: Biliary stone disease is a frequently encountered problem among the population with a variety of causes and resulting in a wide range of symptoms from vague abdominal discomfort to life-threatening conditions requiring urgent surgical intervention. Magnetic resonance cholangiopancreatography (MRCP) has become a noninvasive radiological diagnostic method extensively used in the evaluation of the biliary tract providing excellent anatomical detail. Apart from the classical causes widely described in the literature in stone etiology, the effect of anatomical variations of the bile tract is a subject that has been investigated recently. The present study aimed to manifest the effect of anatomical variations of the extrahepatic biliary tract on the etiology of choledocholithiasis. Methods: The data of 182 patients who underwent MRCP in our hospital between 2016 and 2021 were retrospectively scanned. The patients were divided into two groups, asymptomatic patients and acute cholangitis. Cystic duct, common hepatic duct, choledochal lengths, and variations in cystic duct opening were analyzed by an experienced radiologist in MRCP. Results: The relation was detected between the cystic choledochal variance of the patients (p&lt;0.001). The cystic duct length of the patients showed statistically significant differences (p&lt;0.05). Conclusion: When the extrahepatic bile duct variations were evaluated, some notable values were found for the etiology, as well as being critical in acute cholangitis. There is a need for studies with larger sample sizes in the literature on this subject.

Anatomic Variations of the Cystic Duct in Magnetic Resonance Cholangiopancreatography in Shiraz: A Cross-Sectional Study.

Background: Anatomic variations of the cystic duct (CD) are commonly encountered. Being aware of these variants will reduce complications subsequent to surgical, endoscopic, or percutaneous procedures. Magnetic resonance cholangiopancreatography (MRCP) is the least invasive and the most reliable modality for biliary anatomy surveys. This study aimed to determine the prevalence of cystic duct variations in the Iranian population.Methods: In this retrospective cross-sectional study, MRCP images of 350 patients referred to Shiraz Faraparto Medical Imaging and Interventional Radiology Center from October 2017 to October 2018 were reviewed. The CD course and insertion site to the extrahepatic bile duct (EHBD) was determined and documented in 290 cases. Descriptive statistics and Chi square test were applied for data analysis via SPSS software.Results: About 77% of cases revealed the classic right lateral insertion to the middle third of EHBD. The insertion of CD to the upper third and the right hepatic duct was 10%, and the insertion to the medial aspect of the middle third of EHBD from anterior or posterior was noted to be about 7.6%. From 2.8% of insertions to the lower third, 1% demonstrated parallel course, and finally, 0.3% of cases presented short CD.Conclusion: CD variations are relatively common, and MRCP mapping prior to the hepatobiliary interventions could prevent unexpected consequences.

Complete Transition from Open to Laparoscopic Living Donor Hepatectomy: 8-Year Experience with More than 500 Laparoscopy Cases

Background: We designed this study to comprehensively review the laparoscopic living donor liver transplantation of our institution. Method: Living donor liver transplantation cases performed since the first laparoscopic living donor hepatectomy, until reaching 500th laparoscopic cases were reviewed. Laparoscopic cases were compared to open cases in a yearly basis, regarding the donor selection, donor morbidity, recipient morbidity and operation time. Results: During the period of May 2013 to July 2021, 754 living donor liver transplantations, 506 laparoscopic and 247 open cases were performed. Complete transition to laparoscopy was achieved in 2020, performing 112 transplantations laparoscopically. Variation of bile duct type of donor became similar in 2018. (P=1.000) There were no differences in the occurrence of grade III complication of donor and recipient throughout the study period. Mean donor operation time were significantly longer in the laparoscopy group which became similar since 2017 (P=0.313) There were no differences in the mean operation time of recipients throughout the study period. Regarding graft survival and overall survival of the recipient, there were no difference between the two group throughout the period. Conclusions: In the initial period, donor selection existed especially for bile duct variation maintaining the safety of the donor and recipient. However, with accumulated experience, complete transition to laparoscopy became possible after 7 years of practice.

Time Series Analysis of Evaporation Duct Height over South China Sea: A Stochastic Modeling Approach

The evaporation duct could significantly affect the work status of maritime microwave communication systems in the South China Sea. Therefore, the exact forecasting of the evaporation duct is vital for the normal operation of the systems. This study presents a stochastic modeling approach to predict the future trends of the evaporation duct over the South China Sea. The autoregressive integrated moving average (ARIMA) model has been used for modeling the monthly evaporation duct height estimated from the Climate Forecast System Reanalysis dataset released by the National Centers for Environment Prediction. The long-term evaporation duct height data were collected for a period of 10 years from 2008 to 2017. The analysis of correlation function reveals the existence of seasonality in the time series. Therefore, a seasonal ARIMA model with the form as ARIMA (0,0,1) × (0,1,2)12 is proposed by fitting the monthly data optimally. The fitted model is further used to forecast the evaporation duct variation for the year 2018 at 95% level of confidence, and high-accuracy results are obtained. Our study demonstrates the feasibility of the proposed stochastic modeling technique to predict the future variations of the evaporation duct over South China Sea.

A Single Centre Experience With Routine Magnetic Resonance Cholangiopancreatography in the Management of Patients With Gall Stone Disease.

Aim: To evaluate the role of preoperative magnetic resonance cholangiopancreatography (MRCP) in detection of common bile duct stone (CBDS) in cases of gall stone disease (GSD).Methods: This is a retrospective study with a prospectively maintained database, carried out in 116 patients who underwent laparoscopic cholecystectomy (LC) for GSD, from October 2017 to September 2020. Preoperative MRCP was performed in all cases.Results: MRCP detected CBDS in 23 out of 116 patients (19.8%) including silent CBDS in seven patients (6%). In situations of normal biochemical parameters and USG abdomen, 30.4% unnoticed CBDS out of all 23 CBDS, were discovered by MRCP. The sensitivity and specificity of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) [positive predictive value (PPV): 24%; negative predictive value (NPV): 81.3%], alkaline phosphatase (ALP) (PPV: 63.2%; NPV: 88.7%), serum total bilirubin (PPV: 57.1%; NPV: 88.4%) and CBD diameter (PPV: 61.5%; NPV: 85.4%) were, respectively, 26.1% and 79.6%, 52.2% and 92.5%, 52.2% and 90.3%, and 34.8% and 94.6%. Cystic duct variations found in nine patients (7.75%). There was no bile duct injury (0%) noted in post operative patients.Conclusion: With normal biochemical and USG parameters, MRCP is a valuable non-invasive investigation to detect the overlooked CBDS. After recognising the cystic duct variants, it may be possible to prevent bile duct injury. Before performing a laparoscopic cholecystectomy (LC) in GSD, a routine preoperative MRCP is highly recommended.

Anatomical variations of the thoracic duct in the dog.

Anatomical variations can be frequently found in the lymphatic system, which is also true for the shape and course of the thoracic duct (ductus thoracicus), the biggest lymph vessel in the body. From 2012 to 2019, the thoracic duct was successfully dissected in 43 dog carcasses that were used in the anatomy course at the Faculty of Veterinary Medicine, University of Zagreb. The thoracic duct originated from the cranial border of the cisterna chyli as one lymph vessel in 36 dogs (83.7%), as two vessels in six dogs (14%) and as three vessels in one dog (2.3%). We divided the observed thoracic duct variations into six groups according to their anatomical similarities. Considering the specific embryonic development, we can conclude that all observed variations are the result of minor deviations from the standard ontogenesis. However, the importance of thoracic duct variations is significant in surgical procedures done in the thoracic cavity to prevent or cure the chylothorax. Since this research showed variations in 39 out of 43 dogs (90.7%) throughout the whole course of the thoracic duct, great care must be taken while performing the ligation or embolization of the thoracic duct.

Correlation Of Magnetıc Resonance Colangiopanchreatography Bile Duct Image Data With Laboratory Data

Purpose: Several etiologies come to the fore in gallstones' formation, especially the chemical content of bile and impaired motility of the gallbladder. This study aims to reveal the connections by evaluating the radiological images and laboratory data of patients who underwent MRCP for any reason in our center. Material and Methods: The data of patients who underwent MRCP with a pre-diagnosis of cholestasis in a single center in 2019-2020 with the ethics committee's approval were retrospectively analyzed. Choledock diameter, presence of cholelithiasis and choledocholithiasis, and variation of the cystic duct were evaluated on MRCP images. In addition, laboratory data were examined, and the relationship between them was statistically compared. Results: Of the 193 patients who underwent MRCP with a pre-diagnosis of bile duct pathologyi, 59.1% were female(n=114), 40.9% were male(n=79). Their mean age was 63,1±19,4. While the cystic duct was normal in 35.3%(n=68) of the patients, 64.7%(n=125) had anatomical variation. There was no difference between genders in terms of the presence of variation in the cystic canal. There was no significant relationship between the presence of variation and gallstones. A positive correlation was found between common bile duct diameter and presence of gallstones and WBC, neutrophil, and ALP values. Conclusion: Although it is thought that bile duct variations may be effective in the formation of gallstones, it was observed that the variational cystic duct was not effective in gallstone formation in our case series. In MRCP, we found that the increase in the diameter of the common bile duct and the high values of WBC, neutrophils, and ALP support the presence of gallstones.

Stepwise development of robotic donor right hepatectomy according to the anatomical variations in the hilum and the graft volume

Initial strict selections of donor without anatomical variations are recommended for minimally invasive living donor liver transplantation (LDLT) program because the donor safety is the most paramount. In this study, we introduced our stepwise development of robotic donor LDLT from donors with from favorable to unfavorable anatomies. From Apr. 2016 to Oct. 2020, 80 donors received robotic donor right hepatectomy. All donors were divided according to the variations of the portal vein and bile duct and the graft volume (> 800 cc). Donors who had at least one variable that satisfy beyond the three extended criteria were defined as 'unfavorable group'. The proportion of variations was analyzed according to the four periods and perioperative outcomes were compared between favorable and unfavorable group. Among 80 cases, portal vein variation and bile duct variation were observed 10 cases and 22 cases, respectively. Donors who had graft weight more than 800 g were 22 cases. Unfavorable group donors were 8 cases in 1st and 2nd period, respectively. In 3rd period, 9 donors were unfavorable group. In recent 20 cases, 14 donors were unfavorable group. Comparing the perioperative outcomes between favorable and unfavorable group, there were no significant differences regarding total operative time, warm ischemic time, estimated blood loss and postoperative complication. Stepwise development of robotic donor right hepatectomy showed comparable perioperative outcomes in donor with the anatomical variations in the hilum and larger graft volume and seems to a reasonable way for a safe and successful minimally invasive LDLT program.