Clinical feasibility of direct cholangiography via a PTGBD tube during laparoscopic living-donor hepatectomy.

PURPOSES: Accurate biliary visualization is essential for laparoscopic living-donor hepatectomy. We evaluated the feasibility of PTGBD-based direct cholangiography through percutaneous gallbladder puncture during pure laparoscopic left lateral sectionectomy (Lap-LLS) in living donor liver transplantation (LDLT). METHODS: From February 2023 to December 2025, 31 LDLTs using left lateral section grafts were performed at our institution. PTGBD-based transgallbladder direct cholangiography was performed to delineate the biliary anatomy and assess the bile duct transection line in relation to the hepatic duct bifurcation. RESULTS: Direct cholangiography via gallbladder puncture was successfully performed in 30 donors, excluding the initial case, providing clear and repeatable visualization of the biliary anatomy. This technique enables reliable and repeated confirmation of safe bile duct division. No donor stump leakage, stricture, or recipient anastomotic leakage or stricture occurred postoperatively. CONCLUSIONS: PTGBD-based direct cholangiography is a feasible adjunct to pure Lap-LLS and it may facilitate precise bile duct division in minimally invasive LDLT.