Preoperative simulation with a 3-dimensional printed solid model for one-step reconstruction of multiple hepatic veins during living donor liver transplantation.

Meticulous preoperative volumetry of the partial liver graft is essential for both assessing the postoperative graft function and to ensure the donor safety in the field of living donor liver transplantation (LDLT). We herein report the case of a 53-year-old patient who underwent LDLT for hepatitis C virusinfected liver cirrhosis complicated with hepatocellular carcinoma. Preoperative 3D images were obtained using a 3D image analysis system to evaluate the graft volume and possible congested volume after implantation in LDLT, which revealed that a large middle hepatic vein drained a vast area in the right lobe. The extended left graft was considered to be small for size of the recipient, with an estimated congested area of 407 ml, which was equivalent to 39% of the donor’s liver volume in the remnant right lobe. We decided to use a right lobe graft with the middle hepatic vein, because the volume was considered to be sufficient. A preoperative contrast-enhanced CT scan revealed a distance of 2 cm between the donor’s right hepatic vein and middle hepatic vein at the estimated Cantlie line. Because of the location, we planned to use autologous portal vein Y-graft interposition for the hepatic venous anastomosis. Three-dimensional printed solid models of the donor’s right lobe graft and the Y-graft from the recipient’s portal vein were also made for preoperative simulation using the Vincent program. Based on the estimation, we were able to evaluate whether to reconstruct the middle hepatic vein tributaries or anomalous hepatic veins in LDLT. The 3D solid model was effective for preoperative simulation and planning, which made it easy to imagine the reconstructed shape of the anastomosis with appropriate spatial perception.