米国臨床留学日記: 腹部移植外科

2018年から米国中西部に臨床留学中。留学日記を中心に、関心のある医療トピック(移植外科、癌、肥満外科、予防医学) 趣味の筋トレ、ダイエット、書評、 中心に情報発信していくブログです。

memo: Procurement for MVT graft

Warm phase

  • Cruciate incision
  • ligate and cut teres
  • mobilize liver 
  • Cattell-Braasch maneuver, mobilize right colon, intestine, and duodenum from retroperitoneum
  • Dissect and encircle distal part of abdominal aorta
  • Dissect omentum from transverse colon, resect omentum with preserving the arch of the right gastroepiploic artery, and ligate and cut short gastric artery( free up stomach from spleen)
  • Cut transverse colon with GIA, with preserving MCA&V to graft side
  • Dissect splenic flexure from spleen
  • Ligate and cut IMV
  • Mobilize spleen and pancreas
  • Visualize the root of SMA and celiac trunk
  • Dissect and encircle supra-celiac aorta for cross-clamp

 

Discuss with thoracic team

  • Where to cut cava
  • Let thoracic team preserve descending aorta (We need it for tube)
  • Need to get carotid artery for potential Y-graft
  • Ask anesthesia  to pull out NG tube (before you cut esophagus)

 

Cold phase

  • Dissect esophagus and cut it with GIA
  • Cut descending aorta
  • Dissect and resect liver from diaphragm
  • Encircle lower hepatic cava, visualize right and left renal vein
  • Cut lower cava with enough length of venous cuff to kidney graft
  • Visualize the root of SMA and celiac trunk
  • Cut aorta with enough arterial cuff to the root of SMA
  • Take out en-block MVT graft