Figure 1. Stepwise illustration of portal vein cannulation procedure.

(A) Abdominal anatomy. (B) Midline incision and laparotomy, with leftward externalization of intestines and overlying duodenum. (C) Externalization of left liver lobe superiorly. (D–F) Proximal vessel loop is loose. Using a 10-0 nylon micro suture, a stitch is placed in the anterior one-fourth of the vein, 3 mm distal to the vessel loop. The needle from this stitch is placed in the anterior one-fourth of the vein 1 mm proximal to the stitch. (G) The vessel loop is pulled taught. The guide wire is used to facilitate insertion. (H) The guide wire is withdrawn. The suture ends are tied together, slightly crimping the catheter. (I) The vessel loop is loosened and cut. Each of the tails of the suture are wrapped around the catheter twice and tied to create a “Chinese finger trap” effect. (J) Two anchor stitches are placed in the mesentery of the duodenum to secure the catheter. The catheter is externalized from the left lower quadrant and anchored to the peritoneal side of the abdominal wall. (K) The abdominal wall is closed, and the catheter anchored to the inferior aspect of the closure. (L) The osmotic pump is placed in the interscapular s.c. space. The skin is closed. Reproduced with permission from the Cleveland Clinic Center for Medical Art & Photography ©2021. All Rights Reserved.