1. Liver Transplantation – Surgical Procedure1
Liver Transplantation – Surgical Procedure

2. 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

3. Orthotopic Liver Transplant3
Orthotopic Liver Transplant
A cirrhotic patient with marked ascites and an umbilical hernia is shown.

4. Orthotopic Liver Transplant4
Orthotopic Liver Transplant
After exposure of the abdomen, the cirrhotic liver, entire hilum, and gallbladder are identified.

5. Orthotopic Liver Transplant5
Orthotopic Liver Transplant
The falciform ligament with the blackened area
where the xiphoid process has been excised is seen.

6. Orthotopic Liver Transplant6
Orthotopic Liver Transplant
The peritoneum is tacked up to the abdominal wall. The adjacent cirrhotic liver is seen.

7. Orthotopic Liver Transplant7
Orthotopic Liver Transplant
The left hepatic artery after it has been encircled is now ready to be divided.

8. Orthotopic Liver Transplant8
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.

9. Orthotopic Liver Transplant9
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.

10. Orthotopic Liver Transplant10
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.

11. Orthotopic Liver Transplant11
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.

12. Orthotopic Liver Transplant12
Orthotopic Liver Transplant
The suprahepatic vena cava anastomosis between the donor and recipient is completed.

13. Orthotopic Liver Transplant13
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.

14. Orthotopic Liver Transplant14
Orthotopic Liver Transplant
The liver has been completely reperfused after the artery and the portal vein have been sewn.

15. Orthotopic Liver Transplant15
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.