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 (Dont go too low, otherwise you would injure renal artery. Thick ganglion is a kind of merkmal. Cut up clus and expose supraceliac aorta.
- Pay extra attention not to injure renal artery especially when you do pediatric donor. Renal artery branching closer from SMA than adult.
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
- 1L more flush at back bench.
