Young Seok Han, Heon Tak Ha, Jae Min Chun, Yoon Jin Hwang. 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 present initial experiences and safety for totally laparoscopic living donor right hepatectomy.
In 20 cases who received elective living donor right hepatectomy for adult-to-adult LDLT, totally laparoscopic approach was applied from May 2016 up to August 2017. The anatomical variation of portal vein was not considered as an exclusion criteria, but all donors were with Type I portal vein variation. The bile duct anomaly was preoperatively evaluated with magnetic resonance cholangiopancreatography (MRCP) and was never excluded for totally laparoscopic approach.
2D conventional rigid 30º rigid laparoscopic system was used in 2 cases and the remaining 18 cases used 3D flexible laparoscopic system.
In about 40%, hepatic duct anomalies (Type 2, 3a, 3b) were identified. The operation time was from 6 hours to 7 hours. And the time for the graft removal was within 15 minutes. The hepatic duct transection was performed under operative cholangiography via a cystic duct and the patency of left hepatic duct was also confirmed by operative cholangiography. However, during postoperative period, bile leakage was identified in only 1 case and resolved after the biliary stent insertion by ERCP. During operation, there was no transfusion and the inflow control like Pringle maneuver was not used at all. V5 or V8 were reconstructed in 19 cases and large right inferior hepatic vein was prepared for anastomosis in 6 cases. All grafts were removed through the supra-pubic transverse incision. Most donors were discharged at 7 days after hepatectomy. During the short-term follow-up period in the donors except this case, complications were not identified.
Conclusively, totally laparoscopic right donor hepatectomy in elective 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: 87793
Program Number: P524
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster