Elsevier

Surgery

Volume 150, Issue 5, November 2011, Pages 1002-1005
Surgery

Surgical Technique
Elective living donor liver transplantation by hybrid hand-assisted laparoscopic surgery and short upper midline laparotomy

https://doi.org/10.1016/j.surg.2011.06.021Get rights and content

Background

Although the technique of liver transplantation is well developed, the invasiveness of the operation can be decreased with laparoscopic procedures.

Methods

We performed elective living donor liver transplantation (LDLT) through a short midline incision combined with hand-assisted laparoscopic surgery (HALS). Nine selected patients with end stage liver disease underwent the procedure between July, 2010 and February, 2011 (median age 60, median Child-Pugh 9, median MELD score 14). Splenectomy was performed simultaneously in 7 cases. The liver (and spleen) were mobilized by a sealing device under a HALS procedure with an 8-cm upper midline incision, followed by explantation of the diseased liver (and spleen) through the upper midline incision which was extended to 12 to 15 cm. Partial liver grafts were implanted through the upper midline incision.

Results

The median duration of the operation was 741 minutes, the median time needed for anastomosis was 48 minutes, the median blood loss was 3,940 g, and the median liver weight was 866 g. Eight recipients are alive and have good graft function. A difficult implantation for one patient required an additional right transverse incision. When compared with 13 recent liver recipients who underwent LDLT with a regular Mercedes-Benz-type incision, no clinically relevant drawbacks of the HALS hybrid procedure were observed.

Conclusion

We have shown the feasibility and safety of LDLT performed through a short midline incision without abdominal muscle disruption with the aid of HALS.

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)

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