Right Hemihepatectomy for Living Donor Liver Transplantation in Adults (Open Technique)

  • Luciano De Carlis
  • Paolo AseniEmail author
  • Stefano Di Sandro
  • Iacopo Mangoni
  • Raffaella Sguinzi
  • Andrea Lauterio


In this Chapter we discuss the technical details of the right hemihepatectomy for living donor liver transplantation in adults by open technique. Successful donor outcome and the recipient’s hope for the highest probability of a successful transplant are relevant factors that ethically support the choice for living donor liver tranplantation.

The liver’s extrahepatic vasculobiliary anatomy should be carefully determined by recognizing preoperatively all different types of the anatomical pattern. Graft weight/recipient weight ratio >0.8 % and a graft volume/standard liver volume ratio >40 % are the safe limits to avoid small for size syndrome in recipients. During right hemiepatectomy leave untouched the left triangular ligament or the gastrohepatic ligament, because their section produces an excessive mobility of the left lobe with possible torsion or kinking and outflow occlusion of the remnant graft. Throughout the hilar dissection, extreme care should be employed to avoid the devascularization of the common bile duct with possible ischemic biliary stricture in the donor. The preservation of the mean hepatic vein avoids the congestion of S IV and subsequent liver dysfunction in the donor. Try to perform extensive revascularization of all hepatic vein tributaries of the MHV (V5, V8) and all accessory hepatic veins (V6 and V7), when with caliber >4 mm. To maintain the correct parenchyma transection plane, the “hanging maneuver” may be useful.


Hepatic Artery Hepatic Vein Live Donor Liver Transplantation Deceased Donor Biliary Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Accessory hepatic vein


Deceased donor


Hepatic vein tributaries


Living donor liver transplantation


Left hepatectomy


Left lateral segment


Middle hepatic vein


Right hemihepatectomy


Right hepatic vein


Segment (roman numeration refers to each segment)


Split liver transplantation


Small-for-size syndrome

V 1-8

Vein (hepatic accessory or tributary; Arabic numeration refers to each single segment)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Luciano De Carlis
    • 1
  • Paolo Aseni
    • 1
    Email author
  • Stefano Di Sandro
    • 1
  • Iacopo Mangoni
    • 1
  • Raffaella Sguinzi
    • 1
  • Andrea Lauterio
    • 1
  1. 1.Department of Surgery and Abdominal TransplantationTransplant Center, Niguarda Ca’ Granda HospitalMilanItaly

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