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Method Article

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

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DOI:

10.3791/56392

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April 8th, 2018

 ,  ,  ,  ,  ,  , 
1Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, 3Department of Transplantation, The First Affiliated Hospital of Wenzhou Medical University, 4Department of Surgery, Perelman School of Medicine at the University of Pennsylvania

* These authors contributed equally

In This Article

Summary

Here, a protocol involving re-arterialized rat partial liver transplantation is presented. Specifically, 70% liver was resected in vivo by using an updated technique of vessel-oriented hepatectomy. The hepatic artery was reconstructed in an end-to-side manner. The cuff technique was modified to shorten the anastomosis time of the infrahepatic vena cava.

Abstract

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. To better understand the mechanism behind these surgical procedures, a rat partial liver transplantation (PLTx) model was established for relevant surgical studies. Because of the complexity of the rat PLTx model, a protocol with detailed descriptions is required. An article published previously reported a protocol in which ex vivo hepatectomy was used to achieve 50% rat PLTx. In contrast to this protocol, we introduced a re-arterialized PLTx with an in vivo 70% hepatectomy. An updated vessel-oriented hepatectomy was incorporated into the rat PLTx to refine the microsurgical procedure. The portal veins and hepatic arteries of the left lateral lobe and the median lobe were individually dissected and ligated before removal of the liver parenchyma, thereby decreasing the probability of bleeding in the remnant liver stump. Furthermore, an end-to-side vessel anastomosis between the common hepatic artery and the enlarged proper hepatic artery was introduced to re-arterialize the hepatic artery. By using this end-to-side vessel anastomosis technique, the diameter of the anastomosis was enlarged, thereby decreasing the difficulty of hand suture and maintaining a high rate of anastomotic patency. Moreover, the cuff anastomosis of the infrahepatic vena cava was slightly modified. A section of circumferential liver parenchyma around the vena cava of a recipient was preserved during cuff anastomosis to maintain the three-dimensional shape of the vascular lumen. This section of liver parenchyma was removed after completing the anastomosis. With this modification, the step involving placement of stay sutures was omitted, thereby further shortening the cuff anastomosis time. By using this protocol of rat PLTx, a low liver enzyme level, an intact liver lobular architecture and a high survival rate were achieved after microsurgery.

Introduction

Currently, there is a large discrepancy between the number of donated liver organs and the number of patients waiting for a donated liver. The shortage of liver organs is a global problem. To expand the donor pool, split liver transplantation (LTx) and living donor LTx were developed to use a partial liver as a graft1.

To further investigate the mechanism behind partial liver transplantation (PLTx), relevant animal models have been established2,3,4,5. In rat PLTx, the liver lobes are resected in vivo and ex vivo to mimic the conditions of the living donor LTx and split LTx, respectively, in human. A paper published in the Journal of Visualized Experiments presented a detailed protocol involving a 50% rat PLTx using an ex vivo hepatectomy5. However, a rat PLTx with an in vivo hepatectomy has not yet been reported in the visualized literature.

In addition to the difference between in vivo and ex vivo hepatectomies, the technique of performing a hepatectomy itself also plays an important role in determining the outcome of PLTx. Currently, in many surgical studies using the rat PTLx model, the liver lobes were resected after placing a simple ligation at the pedicle of the liver lobe2,3,6,7,8,9. However, placing a simple ligation before resection is not suitable for all liver lobes, as different liver lobes have different shapes and sizes. A simple ligation at the base of the median lobe carries a high risk of causing a constriction of the vena cava, which might eventually affect the outflow of the partial liver graft10,11. Therefore, an update hepatectomy technique based on knowledge of the rat hepatic anatomy is required in the field of rat PTLx.

In the protocol described in this study, an updated vessel-oriented 70% hepatectomy was incorporated into the procedure of the rat PLTx. The portal veins and hepatic arteries of the left lateral lobe (LLL) and median lobe (ML) were dissected and divided individually before removal of the liver parenchyma. Then, the hepatic veins of the LLL and ML were ligated by piercing sutures. By using individual ligations and multiple piercing sutures rather than placing a simple ligation, the remnant stump of the ML was able to spread over the vena cava. Hence, the constriction of the infrahepatic vena cava caused by a surgical ligation was avoided. Additionally, occlusion of the blood supply of the LLL and ML by individual ligations before removal of the liver parenchyma decreased the rate of bleeding in the remnant liver stump, thereby minimizing the influence of blood loss on the experiments11.

For microsurgeons, it is a significant challenge to reconstruct the proper hepatic artery (PHA) of a liver graft because of the extremely small diameter of this vessel. Although the question of whether re-arterialization in LTx is truly necessary is still under debate12,13,14, numerous microsurgical techniques for reconstructing the hepatic artery have been proposed14. Here, we introduce a novel technique for re-arterialization of the liver graft, which anastomoses the common hepatic artery (CHA) to the enlarged PHA in an end-to-side manner. By using this end-to-side technique, two hepatic arteries are connected with an anastomosis of a larger diameter. The larger the diameter of the anastomosis is, the easier hand suturing is to perform and the greater the improvement in the patency of the anastomosis becomes.

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Protocol

All of the procedures followed the guidelines of rodent surgery approved by the Wenzhou Medical University Animal Policy and Welfare Committee 15.

1. Animals

  1. Use male Lewis rats weighing 250-350 g as donors and recipients.

2. Operative Environment

  1. Perform all microsurgical procedures under a surgical microscope with a magnification ranging from 7X to 20X. Sterilize all surgical instruments before use in operation.
    NOTE: The operating room and operating table are clean but not sterile.

3. Basic Microsurgical Maneuvers

  1. Free, dissect, and mobilize the vessel.
    1. First, use straight micro-forceps to lift the surrounding tissue on the vessel.
    2. Second, repeatedly and gently open and close the tips of the curved micro-forceps such that the fine tips can cut open and peel the surrounding tissue on the anterior wall of the vessel.
    3. Third, use straight micro-forceps to clamp and lift the vessel to expose the posterior space. Then, use the tips of the curved micro-forceps to peel the surrounding tissue on the posterior wall of the vessel. Finally, a bald vessel without any surrounding tissue connected should be presented.
  2. Divide or double ligate and divide a vessel or tissue.
    1. First, tie two square knots on the vessel or tissue using two micro-forceps16. Second, cut off the vessel or tissue between the two square knots using micro-scissors.

4. Preparation of the Cuff and Biliary Stent

  1. Make the cuffs of the portal vein and infrahepatic vena cava using 12-gauge and 14-gauge intravenous catheters, respectively, while the biliary stent used is a 22-gauge intravenous catheter. The cuffs consist of a body part and handle part. Use a fillister on the body part to secure the vessel wall onto the cuff (Figure 1).

5. Anesthesia and Fixation of the Rats

  1. Gently place the Lewis rat in an induction box with 5% isoflurane mixed with 0.5 L/min oxygen to induce inhalation anesthesia. Monitor the respiratory frequency of the rat to prevent unexpected death caused by an overdose of isoflurane. Reduce the concentration of isoflurane to 2% to maintain anesthesia when the rat does not respond to pain stimulation.
  2. Move the rat to a 30 cm x 30 cm oak plank covered by a sterilized surgical mat towel, and place the rat in a supine position. Tie the four limbs of the rat using medial tape, and subsequently fix the tape with four thumbtacks. Disinfect the skin using 70% alcohol one time and iodophors three times.

6. Donor Operation

  1. Exposing the operative field
    1. Cut a small transverse incision on the upper abdomen to transect the bilateral inferior epigastric vessels using an electric coagulator.
    2. Extend the transverse incision close to the costal margin on the upper abdomen using surgical scissors.
    3. Reverse and fix the upper abdomen wall and xiphoid process, respectively, to the cranial side.
    4. Move the intestine out of the abdominal cavity with two wet cotton sticks. Cover the intestine using a wet piece of gauze.
  2. Cutting off the ligaments and trimming the suprahepatic vena cava (SHVC)
    1. Cut off the falciformal ligament, coronary ligament and triangular ligament in sequence.
    2. Free the left diaphragmatic vein from the diaphragm using micro-forceps. Then, double ligate it using 6-0 silk sutures.
      NOTE: Do not divide this vein in this step.
    3. Cut off the gastrohepatic ligament using micro-scissors to free the inferior caudate lobe and the hepatoesophageal ligament and artery.
  3. Occluding the blood supply of the LLL and ML before resection (Figure 2)
    1. First, use curved forceps to carefully dissect the posterior wall of the common trunk of the PV that supplies the LLL and left median lobe (LML) from the parenchyma. Second, double ligate and divide it with the corresponding bile duct and hepatic artery together.
    2. Dissect and divide the PV of the RML gently because this vein adheres closely to the liver parenchyma.
      NOTE: 14X magnification is recommended. Do not injure the PV of the right superior lobe, which is close to the PV of the RML.
    3. Identify the hepatic artery and bile duct of the RML located between the PVs of the RML and LML. Double ligate and divide the hepatic artery and bile duct of the RML using 6-0 silk sutures.
      NOTE: A change in the color of the LLL and ML from red to dark red is an indicator of successful occlusion of the blood supply. Thorough knowledge of the vascular anatomy is essential to identifying and dissecting the corresponding vessels. A previous study in rat clearly illustrated the hepatic anatomy by corrosion casts10.
  4. Resecting the LLL
    1. Ligate the pedicle of the LLL using a circumferential 3-0 silk suture to occlude the blood flow of the left lateral hepatic vein. Using micro-scissors, cut the liver immediately above the ligation to remove the liver mass.
  5. Resecting the LML
    1. Clamp the left median hepatic vein by mosquito hemostatic forceps placed along the median fissure (Figure 3A). Remove all of the liver parenchyma of the LML immediately above the forceps using micro-scissors.
    2. Place a piercing suture that penetrates the liver parenchyma immediately under the forceps surrounding the left median hepatic vein. Then, tie a square knot to ligate it before releasing the forceps.
    3. Place another two piercing sutures under the forceps to surround the rest of the open incision of the LML. Then, tie two square knots to close the rest of the incision. Release the mosquito hemostatic forceps to check for bleeding.
  6. Resecting RML (Figure 4)
    1. Place mosquito hemostatic forceps to surround the base of the RML at a distance of 0.5 cm to the SHVC (Figure 4B). Then, cross-clamp the base using the mosquito hemostatic forceps to occlude the right median hepatic vein.
    2. Using micro-scissors, remove all of the liver parenchyma of the RML along the upper surface of the forceps. Be sure to work very close to the surface of the forceps, leaving a plain and thin stump of the ML.
    3. Place the first piercing suture penetrating the liver parenchyma under the forceps to surround the middle median hepatic vein. Then, tie a square knot to ligate the middle median hepatic vein. Place the second piercing suture to ligate the right median hepatic vein using the same method. Place another two piercing sutures close to the rest of the incision following the description in 6.5.2.
  7. Trimming the infrahepatic vena cava (IHVC)
    1. Cut open the retroperitoneum to expose the IHVC. Use curved micro-forceps to free the IHVC and right renal vein from the surrounding tissue. Dissect and ligate the right adrenal vein, which drains into the IHVC from the rear.
    2. Perform a right nephrectomy after ligating the right renal vein and right renal artery to save enough vascular length to install the cuff onto the IHVC in a later step.
  8. Installing the biliary stent
    1. Mobilize the common bile duct (CBD) from the first hepatic hilum using micro-forceps. Ligate the CBD at the cross-point of the pyloric vein and CBD using a 6-0 silk suture.
    2. Cut a transverse incision on the anterior wall of the CBD on the proximal side of the ligation. Insert a biliary stent, made of a 22-gauge intravenous catheter, into the lumen of the CBD via the incision. Secure the biliary stent with a circumferential 6-0 silk suture. Transect the CBD between the two 6-0 silk sutures.
  9. Trimming the PV
    1. Ligate the pyloric vein using a 6-0 silk suture distal to the PV. Next, ligate the pyloric vein using a 7-0 polypropylene suture close to the PV. Transect the pyloric vein between these two ligations. Double ligate and divide the splenic vein in the same way.
      NOTE: Use a 7-0 polypropylene suture to ligate the vessel to make a smaller ligation knot compared with that of the 6-0 silk suture. A large knot may interfere with the cuff installation in the last step. The vascular wall of the pyloric vein and splenic vein is thin, so gentle manipulations are essential during the dissection. A previously published article with more technical descriptions and illustrations about dissecting and dividing the pyloric vein and splenic vein should be read before operation17.
  10. Trimming the common hepatic artery (CHA)
    1. Carefully free the CHA and its two bifurcations, the PHA and the gastroduodenal artery (GDA), from the surrounding tissue using two micro-forceps. Double ligate the GDA using 6-0 silk sutures at the bifurcation of the CHA to GDA.
  11. Heparinizing and perfusing the liver graft
    1. Inject 50 IU of heparin in 1 mL of saline via the penile vein. Wait for 5 min to achieve systemic heparinization.
    2. Cross-clamp the PV, IHVC and CHA using three curved micro-serrefines to occlude hepatic blood flow. Perform a small incision on the anterior wall of the PV to insert a 22-gauge catheter. Perfuse the partial liver graft with saline at 4 °C via the catheter under a pressure of 20 cmH2O.
    3. Rapidly cut open the thoracic cavity and intrathoracic vena cava using surgical scissors to drain out the blood and perfusate. Do not stop the perfusion until the color of the entire partial liver graft becomes uniformly yellow.
  12. Explanting the partial liver graft
    1. Transect the left diaphragmatic vein between the two ligations (described in 6.2.2) using micro-scissors.
    2. Next, transect the SHVC close to the diaphragm to keep the vascular length as long as possible. Transect the PV at the level of the splenic vein using micro-scissors. Divide the GDA between the double ligations, and transect the CHA close to the celiac trunk.
    3. Transect the adrenal vessels on the distal side of the 6-0 silk ligation placed in 6.7.2. Transect the IHVC at the level of the left renal vein using surgical scissors.
    4. Excise and transfer the partial liver to a back-table dish (30 mm culture dish) filled with saline at 4 °C.

7. Back-Table Operation (Graft Preparation)

  1. Installing the vascular cuffs (Figure 5)
    1. Pull the PV through the lumen of a cuff made with a 12-gauge intravenous catheter using micro-forceps. Temporarily fix the cuff handle and PV together using a vessel clamp. Evert the PV vessel wall to cover the outside surface of the cuff. Secure the vessel wall and cuff in position with a circumferential 6-0 silk suture.
      NOTE: Do not twist the vessel. The cuff handle should be kept in the 12 o'clock direction.
    2. Install the IHVC cuff following the descriptions in 7.1.1.
  2. Presetting the two stay sutures onto the SHVC
    1. Penetrate the vessel wall of the SHVC from outside to inside using two 7-0 polypropylene sutures along the 3 o'clock and 9 o'clock directions, respectively.
      NOTE: Do not tie a knot.
  3. Preserving the graft
    1. Immerse the partial liver graft in saline at 4 °C for preservation after the back-table operation.

8. Recipient Operation

  1. Repeat the procedures in 6.1-6.2 and 6.7, except for the right nephrectomy, in the recipient to expose the operative field, transect the ligaments and trim the vessels.
  2. Preparing the IHVC, bile duct, hepatic artery and portal vein in the recipient
    1. First, mobilize the section of the IHVC down to the right renal vein. Second, ligate the right adrenal vessels using a 6-0 silk suture. Third, mobilize the CBD from the first hepatic hilum using micro-forceps.
      NOTE: Do not trim off the fatty tissue around the CBD.
    2. Transect the CBD at the first bifurcation in the hepatic hilum after double ligation using a 6-0 silk suture. Then, transect the PHA using micro-scissors subsequent to the double ligation using a 6-0 silk suture. Mobilize the section of the PV from the hepatic hilum to the pyloric vein.
  3. Mobilizing the rear of the liver
    1. Retract the recipient liver to the left side using two cotton sticks. Then, cut off the ligament in the rear of the liver from the SHVC to the right adrenal vein as described in a previous visualized article18. After this, introduce a rubber band through the back space of the SHVC.
  4. Preparing the instruments and materials during the anhepatic phase
    1. Recheck the availability of all of the instruments and materials required in the anhepatic phase, such as a 5 mL syringe with a curved needle, micro-scissors, micro-needle holder, micro-forceps, two micro-hemostatic forceps, two 7-0 polypropylene sutures and 6-0 silk suture material.
      NOTE: Searching for materials or instruments may prolong the anhepatic phase.
  5. Excising the liver in the recipient
    1. Cross-clamp the IHVC immediately above the renal vein using a vessel clamp and the PV immediately above the pyloric vein. Record the duration of the anhepatic phase from this moment until the clamp on the PV is released.
    2. Reduce the concentration of isoflurane to 0.5% immediately.
    3. Pull the SHVC and diaphragm down by the preset rubber band. Clamp the parts of the diaphragm together with the intrathoracic vena cava using a Bulldog clamp, maintaining a distance of 0.5 cm to the SHVC.
      NOTE: Do not clamp the lung of the rat.
    4. Using micro-scissors, cut the vessel wall of the SHVC carefully along the upper edge of the liver parenchyma to keep the vascular wall as long as possible.
    5. Transect the PV at the first bifurcation in the hepatic hilum using micro-scissors. Then, transect the inferior vena cava in the parenchyma of the right inferior lobe, rather than in the vessel wall, leaving the circumferential liver parenchyma around the vena cava. Keep the cutting edge in the right inferior lobe at a distance of 4 mm to the IHVC. After transecting the vessels, move the whole liver out of the abdominal cavity.
  6. Reconstructing the SHVC
    1. Place the partial liver graft in the abdominal cavity orthotopically. Pierce the vessel wall of the SHVC from inside to outside along the 3 o'clock and 9 o'clock directions using two preset stay sutures. Pull the two stay sutures to the right and left after they are tied into a knot with their own ends.
    2. Pierce the SHVC vessel wall from outside to inside close to the knot in the 3 o'clock direction to introduce the needle of the right stay suture into the vascular lumen.
    3. Anastomose the posterior wall of the SHVC by a running suture inside the vascular lumen from the 3 o'clock direction to the 9 o'clock direction.
    4. At the corner of the 9 o'clock direction, pierce the vessel wall from inside to outside close to the knot to introduce the needle out of the vascular lumen.
    5. Use this suture to anastomose the anterior wall using a running suture outside of the vascular lumen from the 9 o'clock direction to 3 the o'clock direction. Finally, tie the suture with its own end 3 times (Figure 6).
      NOTE: Inject 3-5 mL of saline into the lumen of the reconstructed SHVC to force out air bubbles before the last 2-3 stitches. A more detailed description of SHVC anastomosis can be found in the article by Delriviere et al.19.
  7. Reconstructing the PV
    1. Place two 7-0 polypropylene stay sutures at the end of the PV of the recipient following the description in 7.2. Pull two stay sutures in the opposite direction to extend the vessel wall. Fix two stay sutures using two micro-mosquito hemostatic forceps.
    2. Inject approximately 1 mL of saline into the vascular lumen of the PV in the recipient to force out air bubbles. Quickly insert the portal vein cuff into the vascular lumen of the PV in the recipient to force when it is opened using micro-forceps. Secure the cuff anastomosis using a circumferential 6-0 silk suture. Cross-clamp the CHA.
  8. Reperfusion to liver graft
    1. Release the clamps on the SHVC and PV in sequence to reperfuse the liver graft. Record the time of the anhepatic phase. Check for bleeding of the anastomosis. Increase the concentration of isoflurane to 1-2% according to the reaction of the rat to the pain stimulation.
  9. Reconstructing the IHVC
    1. Inject 1 mL of saline into the vascular lumen of the IHVC in the recipient to force out the air bubbles. Insert the cuff into the cylindrical vascular lumen of the IHVC, which is supported by the circumferential liver parenchyma (Figure 7). Introduce a 6-0 silk suture through the back space of the IHVC. Quickly secure the cuff anastomosis using a 6-0 silk suture.
    2. Release the two vessel clamps in the IHVC to restart the perfusion. Trim off the surrounding liver parenchyma carefully above the circumferential silk suture using micro-scissors.
  10. Reconstructing the hepatic artery
    1. Penetrate the vessel wall of the CHA in the liver graft from outside to inside using two 11-0 polypropylene sutures in the 3 o'clock and 9 o'clock directions, respectively. Occlude the blood flow of the CHA and GDA in the recipient using two curved micro-serrefines.
    2. Transect the PHA of the recipient at its root to expose the vascular lumen using micro-scissors. Enlarge the vascular lumen of the PHA in the recipient by cutting part of the vessel wall longitudinally to accommodate the diameter of the CHA in the liver graft.
    3. Anastomose the CHA of the liver graft to the enlarged PHA in an end-to-side manner using the running suture technique described for the SHVC anastomosis (8.6.2-8.6.7).
      Note: Detailed illustrations can be found in the article by Huang et al14.
  11. Reconstructing the CBD
    1. Move the intestine back into the abdominal cavity to reduce the distance between the two ends of the bile duct. Perform a transverse incision on the anterior wall of the bile duct in the recipient.
    2. Pull the biliary stent in the partial liver graft down to insert it into the lumen of the bile duct in the recipient via the transverse incision. Secure the stent using a 6-0 circumferential silk suture.
    3. Tie the two 6-0 circumferential silk sutures in the bile duct to each other to reduce the tension of the anastomosis.
  12. Closing the abdomen
    1. Close the abdomen in two layers using 3-0 silk suture in the running suture pattern.

9. Postoperative Treatments (Analgesia and Antibiotics)

  1. Treat all recipients with 0.1 mg/kg buprenorphine subcutaneously. Administer cefuroxime (16 mg/kg) subcutaneously in addition to the analgesic drug. Offer tap water and standard laboratory animal chow to the rats ad libitum.

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Results

In total, 31 cases of syngeneic arterialized rat PLTx were completed using this protocol. All of the recipients survived until the end of the observation time. The body weight of the recipients began to recover after postoperative day (POD) 4. The slope of the body weight was close to that of a normal Lewis rat after POD 6 (Figure 8), which indirectly implied the recovery of the recipient. Histologically, a slight proliferation of the bile duct was observed i...

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Discussion

Rat PLTx is a sophisticated microsurgical procedure with a training program that is high in cost and long in duration20. The complexity of the rat PLTx protocol has prevented researchers from using this animal model. Compared with full-size rat LTx, rat PLTx presents the microsurgeon not only with the challenge of a transplantation procedure but also with the challenge of liver resection in a small animal. Therefore, a visualized microsurgical protocol describing the whole procedure in detail is e...

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Disclosures

All authors have no conflicting interests to disclose.

Acknowledgements

This research was supported by National Natural Science Foundation of China (Grant No. 81501382) and Zhejiang Provincial Natural Science Foundation of China (Grant No. LQ13H100003 and LQ16H100002).

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Surgical microscopeMöller-Wedel, Germany654359
Light sourceOSRAM (China) Lighting Co., Ltd64627
Isoflurane VaporizerMIDMARK CorporationVIP3000
IsofluraneBaxter Healthcare Corporation40032609For Inhalation anesthesia
Normal SalineZhejiang Tianrui Pharmaceutical Co., Ltd.716092103
Povidone Iodine SolutionHANGZHOU MINSHENG PHARMACEUTICALH33021567For disinfection
Hemostatic forcepsShanghai Medical Instruments(Group) LtdJ31020
Surgical scissorsShanghai Medical Instruments(Group) LtdJC2116
Needle-holderShanghai Medical Instruments(Group) LtdJ32030
Dressing ForcepsShanghai Medical Instruments(Group) LtdJ42020
Mosquito hemostatic forcepsShanghai Medical Instruments(Group) LtdW40340For liver resection; For retracting the stay sutures. 
Micro-scissorsShanghai Medical Instruments(Group) LtdWA1040
Micro needle-holderShanghai Medical Instruments(Group) LtdWA2060
Curved micro typing forcepsShanghai Medical Instruments(Group) LtdWA3061
straight micro typing forcepsShanghai Medical Instruments(Group) LtdWA3060
Micro hemostatic forcepsShanghai Medical Instruments(Group) LtdWA3020
Bulldog clampShanghai Medical Instruments(Group) LtdXEC350
Vessel clampsShanghai Medical Instruments(Group) LtdW40160
Micro Serrefine-curved Fine Science Tools, Inc18055-05
DacryosyrinxShi Zhuo medical instruments Co., Ltd.5# curveUse as the curved needle for forcing out the air bubbles in the vascular lumen
Sterilized gauze swabsFuqing Health & Integral Medical20230R
5mL syringeZhejiang Yusheng Medical Instrument Co.,Ltd811932416
18G needlesShanghai Kindly Enterprise Development Group Co., Ltd01-014For fixing the upper abdomen wall
Intima II 22G intraveous catheterBecton Dickinson Medical Devices (Shanghai) Co Ltd.383207yFor making biliary stent; For infusing perfusate
7-0 polypropylene suturesNingbo Medical Needle Co., Ltd151026For SHVC anastomsis
6-0 silk sutureShanghai Pudong Jinhuan Medical Products Co., Ltd2650182For ligation
Culture dish (100mm)Corning Incorporated430165used in back table for storage ice. The back table dish was placed on it. 
Culture dish (30 mm)Corning Incorporated3296As a vessel for organ preservation
Angiocath 12G intravenous catheterBecton Dickinson Medical Devices (Shanghai) Co Ltd.382277For making a IHVC cuff
Angiocath 14G intravenous catheterBecton Dickinson Medical Devices (Shanghai) Co Ltd.382269For making a PV cuff
Buprenorphine (hydrochloride)Tianjin Institute of Pharmaceutical Research Pharmaceutical Co., LtdH12020275For analgesic
Cefuroxime sodium for injectionEsseti FarmaceuticiS.r.lH20160013As an antibiotics

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Vessel Oriented HepatectomyEnd to Side AnastomosisCuff Anastomosis ModificationHepatic Artery ReconstructionPortal Vein CannulationInfrahepatic Vena Cava CuffCommon Bile Duct StentingMicrosurgical Liver ProcurementPostoperative Survival Analysis
Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
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