Updates in Surgery最新文献

{"title":"Comprehensive evaluation of the ramification patterns of hepatic vascular anatomy based on three-dimensional visualization technology.","authors":"Zhicheng Liu, Feng Xia, Bin Guo, Chao Leng, Erlei Zhang, Lei Xu, Xiaoping Chen, Peng Zhu","doi":"10.1007/s13304-025-02064-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02064-w","url":null,"abstract":"<p><p>The liver segmentation method proposed by Couinaud is widely accepted by surgeons because of its convenience and practicality. However, this conventional eight-segment classification does not reflect realistic details of the liver and thus requires further adjustments to promote improvements in surgical strategies. This study aimed to explore the ramification patterns of the hepatic vasculature comprehensively. A total of 197 eligible patients meeting the study criteria were enrolled for three-dimensional reconstruction analysis. In the left hemiliver, the portal vein bifurcated into P2 and umbilical portion (UP) in 172 (98.3%) patients. The P4b of 103 patients (103/172, 59.9%) whose P4b branched from the right horn of the left portal vein (LPV) diverged from the main trunk of the UP. In the right paramedian sector (RPMS), the entire portal trunk directly bifurcates into P8vent and P8dor. Simple branching of P5 off the trunk of the RPMS was observed in 78 patients (78/130, 60%). The anterior fissure vein (AFV) was identified in 86 (86/148, 58.1%) patients. V8d entered the right hepatic vein (RHV) in all the patients. In 75.3% (113/150) of all the patients, V5d joined the RHV. In the right lateral sector (RLS), more than half (71/133, 53.4%) of the patients had an arch-like type. We summarize different patterns of liver vascular branches, providing a valuable reference for clinical surgery and liver transplantation. Cranio-caudal segmentation is more common than ventral-dorsal segmentation. The AFV can be regarded as a reliable anatomical landmark for subsegmentation in segment 8. In addition, the absence of AFV was associated with the P8 pattern.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of low anterior resection with and without ileostomy for low, mid and upper rectal cancers.","authors":"Vincent Xu, Kristina La, Rachel Ma, Paola Solis-Pazmino, Abbas Smiley, Moshe Barnajian, Joshua Ellenhorn, Roberto Bergamaschi, Yosef Nasseri","doi":"10.1007/s13304-025-02088-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02088-2","url":null,"abstract":"<p><p>Although the addition of an ileostomy to low anterior resection (LAR) may often be considered preventative of anastomotic leakage (AL), evidence that clearly demonstrates such benefit is lacking. This study aimed to identify the impact of adding an ileostomy upon AL and organ-space surgical site infection (SSI) rates in patients with lower, middle, or upper rectal cancer. This case-control study included rectal cancer patients who had undergone elective LAR in the American College of Surgeons-National Surgical Quality Improvement Program dataset between 2016 and 2022. Patients with lower, middle, and upper tumors were identified and analyzed according to whether an ileostomy was added or not. Patients' pre-, intra-, and short-term post-operative data were compared using univariable and multivariable methods. A total of 4048 patients (61.6% males) with a mean age of 60 years, whereof 1166 with lower, 1836 with middle, and 1046 with upper tumors were identified. An ileostomy was added in 2804 (69.3%) patients. Patients with upper tumors had an ileostomy added less frequently (78.5%vs 74.5% vs 49.9%, p < 0.001). The overall AL and organ-space SSI rates were 4.3% and 6.7%. There were no statistically significant differences in AL and organ-space SSI rates (requiring or not requiring re-intervention or re-operation) between patients with and without ileostomy regardless of tumor location. Multivariable logistic regression controlling for confounding variables showed no association between adding an ileostomy and AL and organ-space SSI rates (requiring or not requiring re-intervention or re-operation) regardless of tumor location. This case-control study did not find any evidence in support of a preventative impact upon AL and organ-space SSI rates of adding an ileostomy to LAR in patients with lower, middle, or upper rectal cancer.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An optimal protective ventilation strategy in lung resection surgery: a prospective, single-center, three-arm randomized controlled trial.","authors":"Seihee Min, Susie Yoon, Hyun Woo Choe, Haesun Jung, Jeong-Hwa Seo, Jae-Hyon Bahk","doi":"10.1007/s13304-025-02091-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02091-7","url":null,"abstract":"<p><p>Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I-III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (V_T) of 4 mL/kg of predicted body weight (PBW) (LV group), medium V_T of 6 mL/kg of PBW (MV group), and high V_T of 8 mL/kg of PBW (HV group). All patients received 5 cmH₂O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO₂/FiO₂ ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO₂/FiO₂ ratio of < 300 mmHg and/or newly developed radiological findings within 72 h after surgery. The MV group showed the highest PaO₂/FiO₂ ratio at 6 h postoperatively (P = 0.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (P = 0.007). During OLV in lung resection surgery, protective ventilation at a V_T of 6 mL/kg with PEEP of 5 cmH₂O may achieve a higher postoperative PaO₂/FiO₂ ratio, reducing the incidence of immediate PPCs.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboembolic prophylaxis in bariatric and metabolic surgery: state-of-the-art according to the results of a nationwide registry study.","authors":"Omar Thaher, Elisabeth Wendt, Martin Hukauf, Roland S Croner, Christine Stroh","doi":"10.1007/s13304-025-02073-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02073-9","url":null,"abstract":"<p><p>The present study employed a large scaled multicenter nationwide study data analysis to elucidate the impact of thromboembolism prophylaxis (TEP) in the context of bariatric and metabolic surgery and to investigate the peri- and postoperative complications associated with TEP. A total of 63,909 patients who underwent primary bariatric surgery between 2005 and 2020 were included in the analysis. The data were collected prospectively and multicentrically in the German Bariatric Surgery Registry (GBSR) and subsequently analyzed retrospectively. A p value of ≤ 0.05 was deemed to correspond to a significant result. 96.65% of patients were prophylactically anticoagulated postoperatively. 99.3% of the anticoagulated patients received low molecular weight heparin on a median of 7 days. With regard to postoperative complications, a significantly higher incidence of transfusion (p < 0.001) or postoperative bleeding requiring surgery (p = 0.002) was observed in the group of patients who underwent TEP. At 0.67% and 0.87% respectively, these were nevertheless rare complications. The incidence of deep vein thrombosis (DVT) (TEP n = 46, no TEP n = 1; p = 0.642) and pulmonary artery embolism (PAE) was 0.1% each (TEP n = 57, no TEP n = 2; p = 0.985). The surgical technique was associated with a minimal risk of consequences for DVT. Here was the occurrence of DVT following surgical procedures in patients with TEP 0.1% for gastric banding (GB) and sleeve gastrectomy (SG), and less than 0.1% for Roux-Y gastric bypass (RYGB). The mortality rate was between patients with TEP and patients without TEP not significantly different (n [TEP] = 102; 0.17%, n [no TEP] = 6; 0.28%) (p = 0.198). The study's findings validate the efficacy of TEP in bariatric surgery. However, to prevent adverse TEP consequences, like hemorrhage, the dosage and timing of prophylactic medication must be appropriately modified. However, it is evident that randomized controlled trials are necessary to establish uniform, high-quality recommendations on TEP.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative risk factors for overall survival of patients with pancreatic ductal adenocarcinoma underwent laparoscopic pancreaticoduodenectomy.","authors":"Jing Zhang, He Cai, Man Zhang, Yunqiang Cai, Bing Peng","doi":"10.1007/s13304-025-02081-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02081-9","url":null,"abstract":"<p><p>The postoperative overall survival of patients with pancreatic ductal adenocarcinoma is not optimal. The aim of this study was to explore the perioperative risk factors for overall survival after laparoscopic pancreaticoduodenectomy (LPD) in patients with pancreatic ductal adenocarcinoma (PDAC). From January 2015 to January 2022, consecutive patients who underwent LPD with a pathological diagnosis of PDAC at our center were included in the study. LASSO regression and multivariate Cox regression were used to explore perioperative risk factors associated with overall survival. A total of 159 patients were included in the study. The median overall survival was 21 months. In the multivariate analysis, the level of direct bilirubin in serum (HR: 1.01, 95% CI 1.00-1.02, P = 0.043), postoperative pancreatic fistula (HR: 0.36, 95% CI 0.18-0.86, P = 0.010), and adjuvant therapy after surgery within 12 weeks (HR: 0.53, 95% CI 0.34-0.83, P = 0.001) were identified as independent risk factors associated with overall survival. A high level of direct bilirubin in the serum, happened with postoperative pancreatic fistula and delayed postoperative adjuvant therapy are prognostic risk factors affecting the overall survival of patients with PDAC after LPD.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application of the KangDuo-Surgical Robot-01 in distal gastrectomy for gastric cancer.","authors":"Zeshen Wang, Pengcheng Sun, Yuming Ju, Shiyang Jin, Qiancheng Wang, Yuzhe Wei, Guanyu Zhu, Kuan Wang","doi":"10.1007/s13304-025-02108-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02108-1","url":null,"abstract":"<p><p>This study aimed to explore the safety, feasibility, and efficacy of using KangDuo-Surgical Robot-01 (KD-SR-01) for distal gastrectomy in patients with gastric cancer. We prospectively enrolled patients undergoing KD-SR-01 assisted distal gastrectomy at our center from September 2023 to December 2023. Data on baseline characteristics, perioperative details, and short-term follow-up were collected prospectively. Descriptive statistical analysis was performed. This study included 15 patients with a median age of 60 years (range: 44-74) and a median body mass index of 24.7 [interquartile range (IQR): 19.8-27.0]. None of the patients required conversion to laparotomy or open surgery during lymphadenectomy. Ten patients underwent D2+ lymphadenectomy, four had D2, and one had D1+. Eleven patients had robotic-assisted BII anastomosis, one had robotic-assisted BI anastomosis, and three had laparoscopic BII anastomosis. All patients had negative surgical margins. The median operative time was 210.0 min (IQR: 200.0-225.0), with a median anastomosis time of 32.0 min (IQR: 21.5-54.5) for robotic-assisted BII anastomosis and 20 min for BI anastomosis. The median estimated blood loss was 30 ml (range: 30-50), and the median postoperative hospital stay was 7.0 days (IQR: 7.0-8.0). Four patients (26.7%) experienced Clavien-Dindo grade II postoperative complications, including two cases of hypoalbuminemia, one case of pneumonia, and one case of moderate anemia, with no device-related complications. Short-term follow-up indicated normal postoperative recovery with no radiographic evidence of recurrence. The KD-SR-01 is safe, feasible, and effective for distal gastrectomy and robotic-assisted gastrointestinal reconstruction.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of sleeve gastrectomy in a patient group with mainly high BMI: a single-center study.","authors":"Anna M Thiel, Andreas Plamper, Julia Kroll, Patrick H Alizai, Sophia M Schmitz, Karl P Rheinwalt","doi":"10.1007/s13304-025-02076-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02076-6","url":null,"abstract":"<p><p>Since long-term results after laparoscopic sleeve gastrectomy (LSG) are rather scarce, this study aims to add LSG results with a minimum of 5 years of follow-up. Prospectively collected data from primary LSG in a tertiary bariatric center from 08/2007 to 12/2018 with follow-up ≥ 5 years were analyzed retrospectively. Primary endpoints included total body weight loss (%TBWL) and excess weight loss (%EWL), insufficient weight loss (IWL), weight regain (WR), remission of associated diseases, development of new-onset gastroesophageal reflux disease (GERD), and nutritional deficiencies. Furthermore, the study focused on incidence, time point, and causes of conversion and revision operations. A total of 207 LSG (132 female, mean age 43 (± 10.7) years) entered this study. 33.3% (52 of 156 without conversion) were lost to follow-up for ≥ 5-year data. Perioperative mortality was 0.5% (n = 1). %TBWL was 27.1% (± 12.4) and %EWL 52.5% (± 24.3). IWL or WR was found in 48.8%, new-onset GERD occurred in 27.5% of cases, leading to conversion in 26.6% and revisions in 2%. Nutritional deficiencies were observed in 23.7%, while resolution of associated diseases was sufficient. This patient group with a mean BMI > 50 kg/m² at baseline showed fair results regarding weight loss issues and remission of associated diseases at ≥ 5 years postoperatively. Yet, a rate of 48.8% of either IWL and/or WR and 27.5% of new-onset GERD required conversion and revision operations in 28.6%. To better learn about long-term results of LSG, further studies preferably with larger multicenter samples and comparisons with alternative primary procedures, preferably in a prospectively randomized approach, possibly with focus on high BMI patients, are required.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of nutritional deficiencies following one anastomosis gastric bypass (OAGB): a single-center experience.","authors":"J Jedamzik, L Pedarnig, C Bichler, J Eichelter, M Mairinger, L Gensthaler, L Nixdorf, P Richwien, N Vock, F B Langer, G Prager, D M Felsenreich","doi":"10.1007/s13304-025-02094-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02094-4","url":null,"abstract":"<p><strong>Background: </strong>Metabolic/bariatric surgery (MBS) remains the most effective and long-lasting treatment for obesity and its complications. Apart from any surgical complications, the often less obvious but possibly severe side-effects of nutritional deficiencies have become of interest in recent years. OAGB is known to come with the need for thorough supplementation.</p><p><strong>Setting: </strong>Retrospective study; university-hospital based.</p><p><strong>Aim: </strong>Assessing nutritional issues and their management in a real-life cohort of patients undergoing OAGB.</p><p><strong>Methods: </strong>Patients that underwent OABG between 01/2018 and 08/2019 were retrospectively assessed. Laboratory values (gained from electronic patients charts) were analyzed for nutritional issues (parathyroid hormone, vitamin A, E, D, B12, folic acid, albumin, ferritin, iron, and transferrin saturation) as well as postoperative complications and reoperations. Furthermore, weight development, improvement/remission of obesity-related complications, and regular intake of multivitamin supplementation (MVS) were assessed.</p><p><strong>Results: </strong>120 patients underwent OAGB; 89 were female. A follow-up was available for 101 patients. Mean length of follow-up was 27.8 ± 20.9 months. OAGB led to a %TWL of 36.7 ± 9.5% and %EWL of 86.8 ± 25.5%. Preoperative deficiencies were vitamin D (53.3%), followed by folic acid (16.7%) and vitamin A (6.7%). During follow-up, every patient developed at least one deficiency, hypovitaminosis D and A were predominant (74.3% and 41.0%), and 31 suffered from folic acid deficiency (30.7%). Hypovitaminosis B12 and calcium deficiency was observed in three patients (2.9%). Although advised to, only 45.5% opted for the intake of specialized MVS, whereas 10% did not take any MVS at all. More than half of all patients (53.5%) took additional supplements. Nineteen patients underwent reoperations associated with the initial OAGB.</p><p><strong>Conclusion: </strong>Two conclusions can be drawn: First, there is a general need for bypass patients to get assessed for a broad array of deficiencies over time. Second, MVS is essential for patients that had bypass surgery. Additionally, compliance needs to be promoted by educating patients as well as other treating physicians.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coaching for improving clinical performance of surgeons: a scoping review.","authors":"Shangdi Wu, Jing Zhang, Bing Peng, Yunqiang Cai, Ang Li, Linxun Liu, Jie Liu, Chunlan Deng, Yonghua Chen, Chunrong Wang, Xin Wang","doi":"10.1007/s13304-025-02077-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02077-5","url":null,"abstract":"<p><p>Surgical coaching has been proven to effectively enhance clinical performance. However, diverse implementation strategies present challenges when initiating new programs. Our scoping review aimed to synthesize the existing literature on surgical coaching, thereby informing the direction of future coaching initiatives. We reviewed published articles in PubMed/Medline and suppletory manuscripts from reference lists. The protocol of our review was registered (osf.io, Z3S8H). Inclusion criteria were studies that provided a detailed description of structured surgical coaching programs aimed at improving clinical performance. Excluded were studies focused on mentoring, teaching, or other forms of coaching that did not align with our specific definition of surgical coaching. We extracted and charted variables such as authors, publication year, geographic region, and others for subsequent analysis. A total of 117 studies were screened, and 11 met our inclusion criteria. Among these, five articles (45%) employed objective metrics to evaluate clinician performance. One study reported on the overall complication rates within 30 days as a measured outcome. Surgeons were the primary coachees in ten of the studies (91%), and the training of coaches was deemed necessary in seven studies (64%). The analyses revealed a preference for expert coaching models (6/11, 55%), video-based coaching (9/11, 82%), and postoperative timelines (7/11, 64%). Various coaching models were identified, including PRACTICE, GROW, and WISCONSIN. As an effective education method, surgical coaching has been conducted in many regions with varied designs. The implementation of structured surgical coaching programs offers substantial benefits for trainers, enhancing efficiency. Future research should focus on generating higher-level evidence, utilizing objective measurement tools, and integrating innovative technologies to further enhance the efficacy of surgical coaching programs.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular outflow reconstruction in right lobe living donor liver transplantation with and without middle hepatic vein.","authors":"Eduardo de Souza M Fernandes, Felipe Pedreira T de Mello, Eduardo Pinho Braga, Camila Liberato Girão","doi":"10.1007/s13304-024-02051-7","DOIUrl":"https://doi.org/10.1007/s13304-024-02051-7","url":null,"abstract":"<p><p>Although living donor liver transplantation has evolved, small-for-size syndrome remains a feared complication. Achieving optimal outflow for the graft with limited donor risk is possible with an experienced team and different techniques. Here we describe the technical aspects of living donor liver transplantation using a right lobe graft, including the different types of grafts, venous reconstructions and the importance of preoperative workup.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}