Liver Transplantation – Surgical Procedure 1 Liver Transplantation – Surgical Procedure

Courtesy and with permission from Dr. Rick Selby Professor of Surgery 2 Courtesy and with permission from Dr. Rick Selby Professor of Surgery Division Chief, Hepatobiliary and Pancreatic Surgery and Abdominal Organ Transplantation Keck Medical Center of USC USA

Orthotopic Liver Transplant 3 Orthotopic Liver Transplant A cirrhotic patient with marked ascites and an umbilical hernia is shown.

Orthotopic Liver Transplant 4 Orthotopic Liver Transplant After exposure of the abdomen, the cirrhotic liver, entire hilum, and gallbladder are identified.

Orthotopic Liver Transplant 5 Orthotopic Liver Transplant The falciform ligament with the blackened area where the xiphoid process has been excised is seen.

Orthotopic Liver Transplant 6 Orthotopic Liver Transplant The peritoneum is tacked up to the abdominal wall. The adjacent cirrhotic liver is seen.

Orthotopic Liver Transplant 7 Orthotopic Liver Transplant The left hepatic artery after it has been encircled is now ready to be divided.

Orthotopic Liver Transplant 8 Orthotopic Liver Transplant The hilar arteries and bile duct are completely taken down with the portal vein exposed in its entirety before going on bypass.

Orthotopic Liver Transplant 9 Orthotopic Liver Transplant The open end of the portal vein is seen and is ready to be intubated for cannulation to go on veno-venous bypass.

Orthotopic Liver Transplant 10 Orthotopic Liver Transplant The abdomen after the liver has been removed, with the diaphragm in the bare area, is seen. The upper clamp is on the suprahepatic vena cava, the lower clamp is on the intrahepatic vein.

Orthotopic Liver Transplant 11 The new liver is brought up to the table. The extenuated state of the liver looks dark. The suprahepatic vena cava of the donor is being held up for suturing.

Orthotopic Liver Transplant 12 Orthotopic Liver Transplant The suprahepatic vena cava anastomosis between the donor and recipient is completed.

Orthotopic Liver Transplant 13 Orthotopic Liver Transplant The intrahepatic vena cava is being anastomosed. Behind the hand of the surgeon and the sponge is a portal vein which is barely shown here.

Orthotopic Liver Transplant 14 Orthotopic Liver Transplant The liver has been completely reperfused after the artery and the portal vein have been sewn.

Orthotopic Liver Transplant 15 Orthotopic Liver Transplant A completed liver in situ is seen. In this particular case no ligaments are sewn, with suspension of the liver because the vascular anastomosis is strong enough to hold the liver in place.