Adequate hepatic artery (HA) flow is the most important contributor to proper graft function in living donor liver transplantation (LDLT). Therefore, in most centers, this is performed by an experienced microsurgeon with an operating microscope. However, it takes a long time to learn the skills involved in this microsurgical reconstruction and to gain experience to achieve good outcomes. To simplify this procedure, a transplant surgeon recently performed the procedure using a surgical loupe. This study retrospectively reviewed the outcomes of 218 LDLTs performed in our institution from January 2012 to October 2016. Before September 2014, an experienced microsurgeon reconstructed the HA under an operating microscope and, after that period, a hepatobiliary surgeon with little experience in arterial anastomosis during LDLT performed it using a surgical loupe.

 A total of 237 LDLTs were performed: 136 in the first period and 101 in the second. The mean time required for the HA reconstruction was shorter in the second period (20.9± 6.9 vs. 24.2 ± 4.3 minutes, P =0.001), while there was no difference in intraoperative arterial revision between the two groups. The incidence of arterial or bile duct complications did not differ significantly between the two groups.

 In conclusion, HA reconstruction under a surgical loupe can be performed simply by the transplant surgeon with a low complication rate and yields results as good as with operative microscopy, even when the surgeon has less experience with HA anastomosis.