Young Seok Han, MD, Jae Min Chun, MD, Heon Tak Ha, MD. Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital
Initial concerns regarding healthy donor’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation (LDLT) have delayed the development of laparoscopic donor hepatectomy in adult-to-adult LDLT. However, decreased blood loss, less postoperative pain, shorter length of stay in hospital, and excellent cosmetic outcome have well been validated as the advantage of laparoscopic hepatectomy. Hence, the safety and feasibility for laparoscopic donor should be further investigated.
We report initial experiences and adequate inclusion criteria for totally laparoscopic living donor right hepatectomy
Totally laparoscopic living donor right hepatectomy in 4 cases were performed from May 2016 up to now. For this procedure, the donors’ right portal vein with long segment of more than 1 cm were preferentially included. The bile duct anomaly was preoperatively evaluated with magnetic resonance cholangiopancreatography (MRCP).
In 2 cases, right posterior hepatic duct originated from left hepatic duct (Type 3b) was identified. Mean operation time was about 7 hours and the warm ischemic time was within 15 minutes. During operation, there was no transfusion and the inflow control like Pringle maneuver was not used. V5 and V8 were reconstructed with artificial graft in 3 cases and large right inferior hepatic vein was prepared for anastomosis in 2 cases. All grafts were removed through the supra-pubic transverse incision. The donors were discharged at 7 days after hepatectomy. We have not observed any complications in the early postoperative follow-up. And, LDLTs from these donors were also successful.
Conclusively, totally laparoscopic right donor hepatectomy in adult-to-adult LDLT can be initially attempted after enough experiences of laparoscopic hepatectomy and LDLT. However, the true benefits of totally laparoscopic living donor right hepatectomy should be fully assessed through various experiences from multi-institutes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79518
Program Number: P473
Presentation Session: Poster (Non CME)
Presentation Type: Poster