Service of Hepato-Biliary Surgery and Liver Transplant, Hôpital St Antoine, Université Pierre et Marie Curie, Paris, France.
Am J Transplant. 2013 Sep;13(9):2467-71. doi: 10.1111/ajt.12361. Epub 2013 Jul 18.
After reporting the first laparoscopic hepatectomy in a living donor for pediatric liver transplantation, we now report a case of pure laparoscopic right hepatectomy for adult transplantation. A 50-year-old female volunteered for living donation to her sister who suffered from primary biliary cirrhosis. The volume of the planned hepatic graft (segments 5-8) was 620 cm(3) , representing 56% of her entire liver. Five ports were used in the donor to perform the operative procedure. The right hepatic artery and portal vein were isolated. Parenchymal division was performed using an ultrasonic dissector, bipolar coagulation and clips for hemostasis. Cholangiography was performed and the right bile duct was cut at the level of a marker thread. The right liver graft was placed in a bag and removed through a 10-cm suprapubic incision. The veins of segments 5 and 8 were recanalized and the graft was transplanted in the recipient. The postoperative course was uneventful for both the donor and recipient. This case offers evidence that the right liver can be procured via a total laparoscopic approach. This technique may allow for an early rehabilitation for the living donor.
在报告首例活体供肝用于儿科肝移植的腹腔镜肝切除术后，我们现在报告一例用于成人移植的纯腹腔镜右半肝切除术。一位 50 岁的女性自愿为患有原发性胆汁性肝硬化的姐姐捐献活体。计划的肝移植物（第 5-8 段）体积为 620cm³，占她整个肝脏的 56%。供体采用 5 个端口进行手术操作。游离右肝动脉和门静脉。使用超声刀、双极电凝和夹闭进行肝实质离断以止血。进行胆管造影，并在标记线处切断右胆管。将右肝移植物放入袋中，并通过 10cm 的耻骨上切口取出。再通第 5 和第 8 段的静脉，并将移植物移植到受体中。供体和受体的术后过程均顺利。该病例为全腹腔镜获取右半肝提供了证据。该技术可能使活体供体更早康复。
