Operative procedure

Living donor hepatectomy was initiated with open or laparoscopic incision. The intraoperative biopsy was performed to determine the suitability of organs for transplantation. During liver mobilization, the pathologic result was reported. Use of the graft was initially decided by an attending surgeon in the consideration of the intraoperative findings and the pathologic report.

Recipient hepatectomy was initiated with a bilateral subcostal incision with cephalic extension. The abdominal cavity was explored to check unreported seeding nodule, and quantify ascites. Standardized anesthesia was performed according to institutional liver transplantation protocol.

The starting time point of recipient anesthesia may vary considering the conditions of recipient and donor. Experts from both departments of surgery and anesthesiology discussed to decide the time point of recipient anesthesia in order to minimize operative duration. In this regard, our policy was updated to preceding recipient hepatectomy over donor hepatectomy in cases with possibility of abortion due to recipient.