The procedure is as follows (Johns Hopkins Medicine, n.d.; Mulholland, Lillemoe, Doherty, Maier, Simeone, & Upchurch, 2010).
An IV line is inserted into the patient’s arm or hand. Catheters are inserted in the neck, the subclavian (under the collarbone) area, the groin and the wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. An additional catheter is inserted into the bladder to drain urine. After the patient is sedated, a tube is inserted into the lungs so that the patient’s breathing can be controlled with a ventilator. Antiseptic solution is applied over the site to be operated on.
The surgeon makes a ‘Mercedes’ incision (Lladó & Figueras, 2004), which is an incision just under the ribs on both sides of the abdomen and extending for a short distance over the breast bone.
The liver’s round ligament is carefully divided between clamps and ligated (tied). After dividing the falciform ligament by cauterization, the incision is opened up by means of a mechanical retractor.
The right and left hepatic arteries are dissected free, ligated, and divided. The proper hepatic artery is also dissected free to the level of the gastroduodenal artery allowing enough length for clamping during the anastomosis. When the replaced right hepatic artery is relatively large and the proper hepatic artery is diminutive in size, the replaced right hepatic artery can be left long and used for arterial inflow for the donor liver. The common bile and common hepatic ducts are dissected, with the longest possible length, while avoiding injury to the bile duct’s blood supply. The common hepatic duct is then ligated as close to the liver as possible. The portal vein is freed from the edge of the duodenum up to its bifurcation, its branching into the right and left portal veins. The liver’s ligamentous attachments are then severed using electrocauterization. The suprahepatic inferior vena cava is freed, with care taken not to damage the hepatic veins. The liver is then cut off of the front of the inferior vena cava. Small branches that run from the inferior vena cava to the liver’s caudate lobe are ligated and divided. Larger branches are clamped, divided, and sewn together. Then liver is dissected from either the right or left aspects until the right, middle, and left hepatic veins are reached.
The patient’s liver is now almost free, with its hepatic veins’ attachments to the inferior vena cava, and in some cases, the portal vein, remaining. In a process called the piggyback technique, a clamp is placed transversely, partially blocking the vena cava to allow some blood to return to the heart. The hepatic veins are divided within the liver. The patient’s liver can now be removed.
The donor liver is brought into the operating scene, and the operating team prepares to rejoin the blood vessels back together, the procedure being called vascular anastomosis. As the piggyback technique has been used, the infrahepatic vein is...