Early duct division in type D Portal Vein anatomy for safe donor hepatectomy-a novel technique

Complex portal venous anatomy encountered in adult living donor liver transplantation poses significant technical challenges, primarily concerning donor safety. This complexity necessitates meticulous and time-consuming backbench reconstruction, rendering it a relative contraindication for donation. Advancements in surgical expertise have enabled successful resolution of many of these intricate anatomical challenges. We report a complex type-D portal vein along with type IIIB biliary anatomy in donor during adult living donor liver transplantation, which was tackled by completing the parenchymal transection and dividing the hepatic ducts before the right anterior portal vein could be delineated. The main portal vein, right posterior portal vein and left portal vein were delineated and the transection line was marked after clamping main portal vein and right hepatic artery. The final delineation of portal venous anatomy with looping of the right anterior portal vein was done after completion of parenchymal transection and division of right anterior and posterior sectoral ducts. During the backbench preparation, right anterior and posterior portal vein were anastomosed to a Y-graft obtained from the recipient explant portal vein to create a single portal inflow orifice. Post-operatively, both the donor and recipient recovered well. In exceptional circumstances, consideration of donors with type-D portal vein becomes viable where the surgical expertise is available.