Image guidance using two-dimensional illustrations and three-dimensional modeling of donor anatomy during living donor hepatectomy

Background: For living donor liver transplantation, preoperative imaging is required for the safety of both the donor and the recipient. We previously initiated our image-guidance program using two-dimensional illustrations and three-dimensional modeling in September 2018; herein, we analyzed the resultant changes in the clinical outcomes. Methods: Living donors and recipients who underwent liver transplantation between September 2017 and August 2019 were included. Cases with image guidance were compared to those without image guidance regarding the operative outcome, especially bile-duct opening in the graft as well as surgical complications. Results: Among 200 living donor transplantation, 90 transplantations were completed with image guidance. The image-guidance group had a higher rate of laparoscopy (80.9% vs. 97.8%; p <.001) as compared with the group without image guidance. Although there was no difference in the type of bile duct (p =.144), more grafts with single bile-duct openings were found in the image-guidance group (52.7% vs. 80.0%; p =.001). Consequently, achievements in bile-duct openings were superior in the image-guidance group (p =.022). There were no differences in bile leakage, graft failure, or number of deaths during the first month post-transplantation. Conclusion: As we initiated our image-guidance program for living donor liver transplantation, clinical outcomes, especially bile-duct division, were improved relative to before implementation.