At the Molinette Hospital in Turin, a liver transplant has been performed for the first time in the world using a totally extra-anatomic technique, saving the life of a 21-year-old girl suffering from biliary tract atresia who had already undergone a first transplant as a child. The young woman, who had entered the waiting list for a second surgery due to severe cirrhosis, no longer had the anatomical connections needed for the new organ graft, as the portal vein, hepatic artery and biliary tract were unusable. Professor Renato Romagnoli's team, with the collaboration of cardiac surgeons, anesthesiologists and perfusionists, opted for an innovative solution. The abdominal aorta was connected directly to the new liver artery, while the portal vein function was replaced with a cavo-portal transposition, using the inferior vena cava. In addition, the biliary pathway was connected directly to a section of the intestine. The surgery, which lasted 14 hours, required the use of an extracorporeal circulation machine for about 80 minutes. Despite the complexity, the liver taken from a young donor resumed functioning immediately after the blood vessels were connected. After five days in intensive care, the patient is now recovering and her condition is stable.