Web-based image transmission: a novel approach to aid communication in split liver transplantation

Background: Split liver transplantation (SLT) is technically demanding and requires good communication between transplant centers. The recipient surgeon receiving a shipped split liver needs detailed information on allocation of inflow and outflow vessels. We describe the first use of an image transmission system to facilitate SLT. Methods: Twenty cadaver livers undergoing ex situ splitting were studied. Fifteen were shared between the geographically separate Birmingham adult and pediatric centers and five were shared with other UK centers. Results: A total of six to eight images of each split graft were taken with a camera at standardized settings using the National Organ Retrieval Imaging System (NORIS), showing details of appearance, size, and anatomy of allocated inflow and outflow vessels. These were uploaded using a personal digital assistant to a secure website (http://www.noris.org.uk). The remote recipient surgeon then viewed these images by logging onto the password-protected website. Minimum time interval between division of the hilar vessels and completion of the split procedure was two h, allowing remote surgeon to view their allocated "shipped'' graft in advance of commencing surgery. Conclusion: This advanced yet simple image transmission system has the potential for routine application in transplant surgery, not only for splitting but also for reporting injuries and graft steatosis.