VT02 Video Transplantation: Living Related Liver 
Selection of Video Presentations from Abstract Submissions
VT02-01 Robotic Living Donor Right Hepatectomy: A Current Standardized Procedure
Hyeo Seong Hwang, Korea, Republic of

H.S. Hwang1, S.Y. Rho1, D.H. Han1, J.S. Choi1, J.G. Lee1, D.J. Joo2, M.S. Kim2, S.I. Kim2, G.H. Choi1
1Division of HBP Surgery, Department of General Surgery, Yonsei University College of Medicine, Korea, Republic of, 2Division of Transplantation, Department of General Surgery, Yonsei University College of Medicine, Korea, Republic of

Since the robotic surgical system was first launched in 2005, the number of robotic surgery has been gradually growing in Korea. The proportion of general robotic surgery is relatively higher than the western countries, but robotic liver resection, especially living donor right hepatectomy is one of the most complex procedures among robotic general surgery. Since its introduction in 1994, living-donor liver transplantation (LDTL) was the standard treatment for both hepatocellular carcinoma and for patients with the end-stage liver disease. Our hospital started robotic living donor program in 2016. Since then, more than 70 cases of robotic living donor hepatectomy have been successfully performed.
In this video, we introduce our current standardized procedure of robotic living donor right hepatectomy from hilum dissection, parenchymal transection, bile duct division to caudate lobe transection, also the ligation of vessels. In addition, we explain how to manage unexpected events during robotic surgery and our journey to expand the indication of donors from favorable to unfavorable anatomy.
VT02-02 Robotic Donor Hepatectomy
Yasir Alnemary, Saudi Arabia

D. Broering1, Y. Alnemary2, Y. Elsheikh1
1Liver Transplant, King Faisal Specialist Hospital & Research Center, Saudi Arabia, 2Organ Transplant Center, King Faisal Specialist Hospital & Research Center, Saudi Arabia

Presenting our technique for totally robotic donor hepatectomy for the right lobe.
VT02-03 Pure Laparoscopic Right Lobe Donor Hepatectomy
Ashish Singhal, India

A. Singhal, V. Chorasiya, A. Khan, M. Qaleem, A. Srivastava, K. Makki, V. Vij
Liver Transplantation & HPB Surgery, Fortis Hospitals, India

Background: Pure laparoscopic donor hepatectomy (PLDH) has become accepted surgical procedure in living donor liver transplantation (LDLT). This study aimed to report our initial experience and outcomes of PLDH and to compare with conventional open donor hepatectomy (DH).
Methods: The medical records of 1175 consecutive (12/ 2011 - 12/2019) live liver donors at our center were retrospectively reviewed. To minimize selection bias, donors who underwent DH after the initiation of the PLDH program were excluded.
Results: 24 donors underwent PLDH. The total operation time (510 minutes [IQR 410-710] vs. 315 minutes [IQR 285-350]; P< 0.05) and time to remove the liver (405 minutes [IQR 360-576] vs. 262 minutes [IQR 242-305]; P< 0.05) were longer in PLDH. The warm ischemic time (11 minutes [interquartile range (IQR) 10-18] vs. 3 minutes [ IQR 2-7]; P< 0.05) was also longer in the PLDH group than the DH group. The length of postoperative hospital stay was shorter in the PLDH group (6 days [IQR 6-8] vs. 7 days [IQR 7-9]). There was no difference in postoperative complications among donors or recipients in both groups.
Conclusions: PLDH is feasible and can be performed safely as DH at an experienced LDLT center. Further analysis including long-term outcome is needed
VT02-04 Robotic Donor Hepatectomy - Lessons Learned
S T Binoj, India

S.T. Binoj1, J. Shaji Mathew2, R. Narayana Menon2, K. Nair2, B. Chandran2, D. Balakrishnan2, U. Gopalakrishnan2, O. Sudheer2, S. Sudhindran2
1GI and Transplant Surgery, Amrita Institute of Medical Sciences, India, 2Amrita Insititute of Medical Sciences, India

We started our robotic live donor programme in June 2018. So far we have performed more than 100 Robotic Donor Hepatectomies, including 90 Robotic Right hepatectomies.
Here we present few cases of robotic donor right hepatectomies where we burnt our fingers.
The four main difficulties we faced during the robotic donor hepatectomies were
1. Haptic Numbness - This results in excessive force on the liver during retraction causing capsular tears and parenchymal injuries.
2. Bile duct anatomy - Performing Intraoperative cholangiogram during robotic surgery is cumbersome and time consuming. Limitations of MR cholangiogram can lead to unexpected multiple ducts in the graft , perhaps causing biliary catastrophe in donors and recipients.
3. Bleeding - This is the most common cause for conversion to open. Bleeding can be from IVC, Portal Vein, Hepatic Veins and Parenchyma. Clip slippages are not uncommon and can cause catastrophic bleed. In case of bleeding coordination among console surgeon, assistant surgeon, anesthesia and nursing paramedical team is paramount.
4. Retrieval - There shouldn't be any hurry during retrieval. Minimal increase in warm ischemia will not make any harm. Following a check list and mock drills will make retrieval smooth as well as safe for both the donor and the graft.
We trust this video will help surgeons performing or venturing into the field of robotic donor hepatectomy.
VT02-07 Combined Right Middle Hepatic Vein Single Orifice Outflow Reconstruction in Modified Right Lobe Live Donor Liver Transplant

V. Pamecha, V. Balaraman Sundararajan, P. Sinha, N. Patil, N. Mohapatra
Liver Transplantation & HPB Surgery, Institute of Liver & Biliary Sciences, Delhi, India

In modified right lobe graft, middle hepatic vein is preserved with the donor. To avoid anterior sector congestion in the recipient a neo-Middle Hepatic Vein (MHV) is routinely reconstructed. We hereby report our technique.
During donor hepatectomy, inferior hepatic veins & venous tributaries of segment 5(V5) and segment 8(V8) larger than 5 mm are preserved for reconstruction with good cuff. Good cuff of right hepatic vein(RHV) is also ensured. Non-ringed expanded (e)-Polytetrafluoroethylene (PTFE) graft is used for creating Neo-MHV. The segment 8 vein is anastomosed in end to side manner& segment 5 in end to end manner to PTFE. The anterior wall of RHV at middle 1/3rd and posterior half circumference of e-PTFE graft are joined to create a single outflow orifice. RHV and neo-MHV single outflow orifice is implanted onto the IVC using a side clamp, instead of fencing. The suprahepatic IVC is mobilized and a side clamp was applied on the IVC at RHV orifice. RHV opening is enlarged cranially up and caudally on to the cava to make it about 2.5x as that of graft RHV opening. The posterior wall of the single orifice is anastomosed to approximately 80% of the posterior wall of the IVC opening. The rest of the posterior and whole of the anterior wall is then anastomosed to the anterior wall of the combined single orifice to accommodate the extra length and thus to create a triangular outflow. Inferior vein is separately reconstructed to IVC.