A Technique of Hepatic Artery Anastomosis with Vascular Clip System in Porcine Orthotopic Liver Transplantation

Tadashi Katsuramaki, Koichi Hirata, Minoru Nagayama, Hitoshi Kimura, Masato Isobe, Takashi Matsuno, Tomohisa Furuhata, Hideki Ura and Mitsuhiro Mukaiya

First Department of Surgery, Sapporo Medical University School of Medicine

The Vascular Closure Staple (VCS) clip application system is easy to use and shortens the time for anastomosis. To investigate usefulness of the VCS clip in anastomosis of the hepatic artery, this device was used in hepatic artery anastomosis in pig liver transplantation. Eighteen pigs weighing 21∼29 kg underwent standard orthotopic liver transplantation using a veno-venous bypass. End-to-end anastomosis of the common hepatic artery, the diameter of which was almost 3 mm, was performed between the recipient and the donor organ. The method was as follows; four stay sutures were built up at both end edges of the anastomosis and at the center of the anterior and posterior walls. S size clips were fired interruptedly between the stay sutures using 3 or 4 clips, with a total number of fired clips of 12∼16. Anastomosis of the hepatic artery was possible without a microsurgery, and the anastomosis was completed within 20 minutes in all cases. Fourteen of 18 pigs (77.8%) survived more than 3 days. Among these 14 pigs, 13 showed patency of the artery with no stenosis until sacrifice (92.9%), and only one pig (7.1%) developed an arterial thrombus at the 10 postoperative day. Problems associated with body growth were not recognized in prolonged survival pigs (45, 90 days).
In conclusion, the VCS clip system facilitates easy arterial anastomosis and shortens the time for anastomosis, with beneficial implications for clinical use.

Key words
vascular anastomosis, VCS clip, liver transplantation

Reprint requests
Tadashi Katsuramaki First Department of Surgery, Sapporo Medical University School of Medicine South-1, West-16, Chuo-ku, Sapporo, 060-8543 JAPAN

Accepted
October 22, 1999

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