[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-420375-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-420375-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","modified-subtraction-technique-for-the-middle-hepatic-vein-tributary-and-glissonean-pedicle-in-right-lobe-graft-procurement","Modified Subtraction Technique for the Middle Hepatic Vein Tributary and Glissonean Pedicle in Right Lobe Graft Procurement","","Right lobe graft procurement in living donor liver transplantation is technically challenging when preserving middle hepatic vein (MHV) tributaries (V5 and V8) just before graft retrieval. Safe isolation of the hepatic duct from the Glissonean pedicle is also essential. This article describes a modified subtraction technique that first manages MHV tributaries after isolating the right Glissonean pedicle, followed by safe duct and hilar plate isolation, enabling preservation during retrieval.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/modified-subtraction-technique-for-the-middle-hepatic-vein-tributary-and-glissonean-pedicle-in-right-lobe-graft-procurement/420375/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/modified-subtraction-technique-for-the-middle-hepatic-vein-tributary-and-glissonean-pedicle-in-right-lobe-graft-procurement/420375.png","ImageObject",300,407,{"name":42,"@type":43},"OmBimo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-05","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What problem does the modified subtraction technique aim to solve in right lobe graft procurement?","Question",{"text":63,"@type":64},"It addresses the technical difficulty of preserving the MHV tributaries (V5 and V8) just before graft retrieval and ensures safe isolation of the hepatic duct from the Glissonean pedicle during living donor hepatectomy.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is the subtraction technique for the MHV tributaries performed?",{"text":68,"@type":64},"The right Glissonean pedicle is isolated first, then a tape is positioned behind the caudate lobe and passed behind the right hepatic vein. The tape ends are directed behind V5 and V8, followed by dissection of the remaining liver parenchyma between them.",{"name":70,"@type":61,"acceptedAnswer":71},"What outcomes were reported for donors who underwent this technique between 2011 and 2025?",{"text":72,"@type":64},"Seven donors underwent right lobe graft procurement using this approach. All middle hepatic vein tributaries were preserved just before graft retrieval, with a mean operative time of 381 minutes and estimated blood loss of 217 ml.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},420375,1790717122,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962090893581,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","doi: 10.21873/invivo.14198  \nModified Subtraction Technique for the Middle Hepatic Vein Tributary and Glissonean Pediclein Right Lobe Graft Procurement  \nKOSEI TAKAGI1, TOMOKAZU FUJI1, KAZUYA YASUI1, TAKEYOSHI NISHIYAMA1,  \nYASUO NAGAI1, SHOHEI YOKOYAMA1, YUZO UMEDA2 and TOSHIYOSHI FUJIWARA1  \n1 Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan;  \n2 Department of Hepatobiliary Pancreatic Surgery, Ehime University Graduate School of Medicine, Toon, Japan  \nAbstract  \nBackground/Aim: The procurement of right lobe grafts while preserving the middle hepatic vein (MHV) tributaries (V5 and V8) just before graft retrieval is technically challenging. Moreover, the safe isolation of the hepatic duct from the Glissonean pedicle is essential in living donor hepatectomy. To date, few studies have reported surgical techniques for preserving the MHV tributaries during right lobe graft procurement.  \nPatients and Methods: This report presents our modified subtraction technique for managing the MHV tributaries and Glissonean pedicle during right lobe graft procurement. First, a subtraction technique for the MHV tributaries was initiated by isolating the right Glissonean pedicle. The lower tip of the tape was placed behind the caudate lobe and passed behind the right hepatic vein. Each end of the tape was then passed behind V5 and V8, followed by dissection of the remaining liver parenchyma between them. Subsequently, a subtraction technique for the Glissonean pedicle was applied to safely isolate the right hepatic duct and hilar plate.  \nResults: Between September 2011 and May 2025, seven donors underwent right lobe graft procurement using the subtraction technique for the middle hepatic vein tributaries. The mean operative time was 381 min with an estimated blood loss of 217 ml. Using the subtraction technique, all middle hepatic vein tributaries were preserved just before graft retrieval.  \nConclusion: This study presents subtraction techniques used during living donor hepatectomy. The technique may facilitate liver parenchyma dissection while preserving MHV tributaries just before graft retrieval and isolating the Glissonean pedicle.  \nKeywords: Subtraction, tape repositioning, middle hepatic vein, donor procurement.  \n+De22n1tistry8775,, aen-d Pmaihl:armaceuticakotakagi15l S@gciemnaiclecso,2m-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Tel: +81 862237151, Fax:  \nKosei Takagi, MD, PhD, Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,  \nReceived October 4, 2025 | Revised October 16, 2025 | Accepted October 17, 2025  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n©2026 The Author(s) . Anticancer Research is published by the International Institute of Anticancer Research.  \nIntroduction  \nLiver transplantation is a well-established approach for the curative treatment of liver decompensated cirrhosis and hepatocellular carcinoma (1, 2). The right lobe of the liver is commonly used as a graft in adult living donor liver transplantation (LDLT). To ensure donor safety, the middle hepatic vein (MHV) should be preserved in the donor’s remnant left liver. In LDLT using the right lobe asa graft, the need for hepatic vein reconstruction –including MHV tributaries (V5 and V8)– has been discussed to prevent venous congestion and outflow obstruction in the anterior sector of the graft (3). However, preserving MHV tributaries just before graft retrieval is technically challenging. Moreover, few studies have described the surgical techniques for preserving MHV tributaries during right lobe graft procurement (4) . Herein, we present our modified subtraction technique for managing the MHV tributary and Glissonean pedicle during right lobe graft procurement.  \nP","cbCaieJNMX0Dq3Pv","https://ap.wps.com/l/cbCaieJNMX0Dq3Pv","pdf",1646398,"English","# Background/Aim\n# Patients and Methods\n# Results\n# Conclusion\n# Introduction\n# Indications for Hepatic Vein Reconstruction\n# Surgical Techniques\n## Subtraction Technique for the MHV Tributary\n## Subtraction Technique for the Glissonean Pedicle","[{\"question\":\"What problem does the modified subtraction technique aim to solve in right lobe graft procurement?\",\"answer\":\"It addresses the technical difficulty of preserving the MHV tributaries (V5 and V8) just before graft retrieval and ensures safe isolation of the hepatic duct from the Glissonean pedicle during living donor hepatectomy.\"},{\"question\":\"How is the subtraction technique for the MHV tributaries performed?\",\"answer\":\"The right Glissonean pedicle is isolated first, then a tape is positioned behind the caudate lobe and passed behind the right hepatic vein. The tape ends are directed behind V5 and V8, followed by dissection of the remaining liver parenchyma between them.\"},{\"question\":\"What outcomes were reported for donors who underwent this technique between 2011 and 2025?\",\"answer\":\"Seven donors underwent right lobe graft procurement using this approach. All middle hepatic vein tributaries were preserved just before graft retrieval, with a mean operative time of 381 minutes and estimated blood loss of 217 ml.\"}]","Modified Subtraction Technique for the Middle Hepatic Vein Tributary and Glissonean Pedicle in Right Lobe Graft Procurement | PDF",1790620712,15]