Introduction : In adult-to-child living donor liver transplantation (LDLT), a pure laparoscopic donor left lateral sectionectomy could be considered as a standard practice with emerging evidences supporting its feasibility and safety. The pure laparoscopic left lateral sectionectomy for living donor with anatomic variations in hepatic artery and bile duct is presented.

Methods : After intraoperative frozen biopsy of the liver and cholecystectomy, mobilization of left side of liver was done through division of falciform ligament, followed by left coronary ligament and triangular ligament division. Thereafter during the division of gastrohepatic ligament, aberrant left hepatic artery originating from left gastric artery was identified and taped with vessel loop. Hilar dissection with identification of middle hepatic artery and left portal vein was performed. Parenchymal division was performed using a combination of CUSA and energy device on the right side of falciform ligament and umbilical fissure. Three times of vascular clamping were used during parenchymal transection. As division of the hepatic parenchyme was completed, left bile duct transection was performed after confirming aberrant right posterior hepatic duct drainage into left hepatic duct through intraoperative cholangiography with fluoroscopy. Procurement of left lateral section graft was performed followed by retrieval through suprapubic transverse incision.

Results : Donor recovery was not eventful and discharged 8 days after the operation. Follow-up CT and hepatobiliary scan after the operation showed no abnormal findings.

Conclusions : Pure laparoscopic living donor left lateral sectionectomy with complicated anatomic variations could be safely performed and feasible option for living liver donors even with these kinds of aberrant anatomy.