Kurosaki Isao, Yamamoto Satoshi, Kitami Chie, Yokoyama Naoyuki, Nakatsuka Hideki, Kobayashi Takashi, Watanabe Takaoki, Oya Hiroshi, Sato Yoshinobu, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Surgery. 2006 May;139(5):695-703. doi: 10.1016/j.surg.2005.12.002.
There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT.
For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used.
VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure.
We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.
近年来腹腔镜肝切除术的技术创新取得了显著进展。然而，在活体肝移植（LRLT）中，腹腔镜手术很少被用于肝脏捐献。在此，我们描述了成人对成人LRLT的电视辅助供体肝切除术（VADH）的技术及结果。
对于13例成人对成人LRLT的供体，通过电视辅助手术实施了3种主要肝切除术——右半肝切除术（3例）以及左半肝切除术（伴或不伴尾状叶，10例）；将通过端口或12厘米切口进行的手术操作与通过腹腔镜或通过切口进行的观察相结合并使用。
13例供体均完成了VADH，中位手术时间为363±33分钟，中位失血量为302±191毫升。未观察到电视辅助手术特有的并发症、术后胆漏或出血。肝功能恢复顺利，与接受标准肝脏捐献的历史对照（中位：3.8次）相比，镇痛药的使用量减少（中位：1.2次）。目前，所有供体均健康并已恢复至术前活动状态。除3例因与电视辅助手术无关的严重并发症死亡的受者外，移植物功能良好。
我们展示了一种通过12厘米剖腹术进行成人对成人LRLT的VADH新方法。该技术与标准开放性供体肝切除术一样可行，疼痛更少，术后症状改善。
