Surgical TechniqueElective living donor liver transplantation by hybrid hand-assisted laparoscopic surgery and short upper midline laparotomy
Section snippets
Materials and methods
Living donor liver transplantation (LDLT) through a midline incision using a hand-assisted laparoscopic procedure was planned in 9 patients between July 2010 and February 2011. Seven patients had liver cirrhosis due to hepatitis C, in whom splenectomy was performed simultaneously. One patient required LDLT because of hepatitis B cirrhosis, and another for Caroli’s disease. The Ethics Committee of Nagasaki University Hospital approved a laparoscopic approach for the living donors as well. After
Results
The Table shows the patient demographics and operation results for our hybrid procedure of LDLT in comparison with LDLT under regular Mercedes-Benz-type incision. Case 2 had massive 3.5-L ascites that was evacuated through the laparotomy. A left lobe graft with the middle hepatic vein was implanted through the upper midline incision in 8 patients. The median duration of the operation was 741 minutes (range, 599–839) with a median blood loss of 3,940 ml (range, 1,300–18,400). The hepatic venous
Discussion
We showed the feasibility of LDLT through a midline incision without abdominal muscle disruption as occurs with the usual transverse incision combined with HALS. Because LDLT is performed usually in an elective manner, this procedure could be planned and prepared for.
Before this study, we had performed 130 LDLTs through the usual transverse Mercedes-Benz-type incisions.8 Based on that experience, we presumed that it would be possible to perform explantation of the liver and spleen followed by
References (15)
- et al.
Laparoscopic living donor hepatectomy for liver transplantation in children
Lancet
(2002) - et al.
Laparoscopic-assisted right lobe donor hepatectomy
Am J Transplant
(2006) - et al.
Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation
Surgery
(2006) - et al.
Upper midline incision for living donor right hepatectomy
Liver Transpl
(2009) - et al.
Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure
Ann Surg
(2010) - et al.
World review of laparoscopic liver resection-2,804 patients
Ann Surg
(2009) - et al.
Laparoscopic splenectomy may be a superior supportive intervention for cirrhotic patients with hypersplenism
J Gastroenterol Hepatol
(2010)
Cited by (31)
Comparison of Upper Midline Incision With and Without Laparoscopic Assistance for Living-Donor Right Hepatectomy
2016, Transplantation ProceedingsTotally laparoscopic living donor right hepatectomy in a donor with trifurcation of bile duct
2016, Asian Journal of SurgeryCitation Excerpt :Superior perioperative outcomes of the donors and comparative recipient results have been shown after laparoscopic left lateral graft harvest.14 For right liver graft harvest in adult liver transplantation, a hand-assisted and laparoscopic-assisted hybrid approach has proved to be beneficial in terms of wound complications and shorter donor recovery.15 The graft quality is comparable to that harvested by traditional laparotomy.16
Hybrid procedure in living donor liver transplantation
2015, Transplantation ProceedingsLiver transplantation in Turkey: Historical review and future perspectives
2015, Transplantation ReviewsCitation Excerpt :Starzl et al. [33] showed that donor leucocytes form chimerism in transplanted liver. Many other advances in liver transplantation, including the importance of portal venous blood [34], the first use of ALG, [26] xenotransplantation attempts from chimpanzees to humans [35], description of brain death concept [36], long-term organ preservation techniques [37], use of vascular grafts for reconstruction [38], use of cyclosporin and steroids in combination [39], use of venovenous bypass pump [40], the first liver transplantation in Turkey [41], the first xenotransplantation attempts from baboon to humans [42], the first extended right lobe transplantation [43], use of laparoscopy and dual left lobe graft [44–49] were summarized on Table 2. The history of liver transplantation in Turkey starts in 1988.
Living-Related Liver Transplantation. Progress, Pitfalls, and Promise.
2014, Regenerative Medicine Applications in Organ TransplantationRole of hand-assisted laparoscopic surgery in living-donor right liver harvest
2013, Transplantation ProceedingsCitation Excerpt :For right liver harvesting, we preferentially use a right subcostal incision. For video-assisted surgery, upper midline, right transverse, or right subcostal incisions are used depending on institutional preferences.1,5,8 Based on our experience of performing laparotomies with a minimal incision, we preferentially use the right subcostal incision.