Using on-site liver 3-D reconstruction and volumetric calculations in split liver transplantation.

BACKGROUND: Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS: Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout© liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS: The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g (930-1458 g) for the extended right lobe donors and 312 g (222-396 g) for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts, respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight. CONCLUSIONS: On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.

Splenic Artery Originating from the Superior Mesenteric Artery: An Unusual but Important Anatomic Variant.

BACKGROUND: Variations in the origin, course, and branching of visceral arteries, particularly those of the celiac artery and superior mesenteric artery (SMA), are well documented in medical literature. Identifying any variation is necessary prior to abdominal surgery. CASE REPORT: A 72-year-old male presented after a pancreatic body mass was incidentally found on abdominal computed tomography (CT). The CT revealed an anatomic anomaly of the splenic artery. The patient's splenic artery originated from his SMA rather than from his celiac artery. CONCLUSION: Accounting for this anatomic anomaly prior to performing an open distal pancreatectomy and splenectomy was essential to the surgery's success. Ligation of the splenic vein followed by early ligation of the splenic artery allowed for minimal splenic congestion. Preoperative planning and understanding the patient's unique anatomy minimized the risk of an adverse outcome.