Simplified technique for middle hepatic vein tributary reconstruction of a right hepatic graft in adult living donor liver transplantation

A simple procedure of direct end-to-end anastomosis between the middle hepatic vein tributary of the right hepatic graft and the preserved recipient middle hepatic vein is described. During the final step of total hepatectomy in the recipient, the middle hepatic vein was preserved, while crushing the liver tissue for a sufficient length of middle hepatic vein to perform tension-free anastomosis with the middle hepatic vein tributary of the graft. This procedure enabled us to avoid using an interposition graft.