Tips for pure laparoscopic right hepatectomy in the live donor.

Donor right hepatectomy is a technically complex and challenging procedure. It is one of the most debated applications of laparoscopy and donor safety is the main concern. The technique described herein uses pure laparoscopic approach with five trocars. After mobilization of the right liver, the right hepatic artery and portal vein are dissected. The liver parenchyma is then divided using an ultrasonic aspirator and an energy device. The middle hepatic vein is kept intact with the left remaining liver. Intra-operative cholangiography allows to determine a safe site for right bile duct division. When parenchymal section is completed, the right liver graft is taken out in a bag through a Pfannenstiel incision.