Intraoperative saline injection as guidance for bile duct division during living donor hepatectomy

Technique Intraoperative cholangiogram with contrast medium is the gold standard procedure for identifying biliary anatomy and locating the appropriate division point for bile duct transection in living donor liver transplantation. However, it is associated with increased operation time, added cost, radiation exposure, and the need for additional equipment and personnel. Moreover, the bile duct is only visible on the monitor instead of by the naked eye. To address these challenges, we propose a new method called intraoperative saline injection, where normal saline is used instead of contrast medium. This technique allows direct visualization of the hilar plate, enabling surgeons to design the cutting line of the bile duct without the need for additional resources. Results With the help of intraoperative saline injection, surgeons can directly visualize the hilar plate and design the cutting line of the bile duct without the need for additional equipment or personnel. Conclusion We believe intraoperative saline injection is a simple, safe, and reproducible procedure with equipment present in an ordinary hepatobiliary operating theater to determine the appropriate division point for bile ducts during living donor hepatectomy.