Mayo stand and back table instruments for Liver Transplant – Recipient surgery setup

Clamping & Occluding

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  Bulldog Clamp

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  Crawford Clamp

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  Curved Hemostat

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  Debakey Mini Multipurpose Clamp

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  Hemostatic Clip Applier

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  Kelly Forceps

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  Mosquito Clamp – Curved

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  Right Angle Clamp

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  Tonsil Clamp

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  Tubing Clamp

Cutting & Dissecting

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  #3 Knife Handle

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  #3 Long Knife Handle

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  Metzenbaum Scissor

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  Stevens Tenotomy Scissor

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  Straight Mayo Scissor

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  Tenotomy Scissor

Grasping & Holding

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  Adson Forceps

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  Debakey Forcep

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  Debakey Micro Tissue Forceps

Retracting & Exposing

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  Thompson Retractor

Suctioning

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

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  Micro Vascular Needle Holder

What to expect during Liver Transplant – Recipient

Positioning: Supine

Drapes: Folded towels or utility drapes, laparotomy drape or the equivalent to an “open belly” drape that your facility has, Ioban

Surgery Steps: A #10 blade loaded on a #3 knife handle will be used to make a bilateral subcostal incision. The bovie will be used a lot during this surgery, so make sure you have an extended tip to put on it for when the surgeon gets deeper in the cavity. Removing the recipients diseased liver is the “hardest” part of the surgery. Once visualized, the diseased liver will be assessed to decide which approach will be best for removal. Once the surgeon has a plan in place, they will begin detaching the diseases liver from all of the surrounding tissue and liver attachments. The important structures like the inferior vena cava, portal vein, hepatic artery, and common bile duct will all be isolated before moving on to transecting them.

Instrumentation will vary based on surgeon preference, but Crawford clamps are commonly used on the inferior vena cava, and mini DeBakey clamps on the portal vein. An Ethicon stapler (or your facilities equivalent) may be used as well. Common sizes used are 45 and 60. Once all of the important structures have been transected the old diseased liver can be removed.

Now the new healthy liver will be sewn into place. The first structures that will be connected are the vena cava and portal veins. 3-0 and 4-0 Prolene are commonly used to attach the vena cava, and 6-0 Prolene is commonly used on the portal vein. Long Debakey pickups, vascular needle holders, and long suture scissors are used while suturing. Next arterial flow will be established by re-connecting the hepatic arteries. This is commonly done with 7-0 Prolene, followed by 6-0 PDS for the common bile ducts. Hemostats or mosquito clamps with booties on them should be available as well to tag suture. New blood will be cycled through the liver (reprofusion) and the surgeon will watch for any bleeding. Warm saline will be poured into the cavity to warm it up to natural body temperature. Two drains are placed as well. You can use the Mayo scissors to cut the drains and 2-0 Nylon is commonly used to suture the drains in place.

Once all of the major structures are re-attached, the surgeon will ensure all of the bleeding has been stopped. Once it has been, the incision will be closed. A stapler is usually used on the skin.

Extra Tips: Always have clip appliers ready. Some surgeons will prefer the disposable ones over the reusable ones, but common sizes are the small and medium clips.

Several sizes of free silk ties should be available to tie off any small attachments. It is also a good idea to have at least 2 asepto bulb syringes on your field for irrigation, and don’t forget your fluid warmer!