Ha T Y, Hwang S, Ahn C S, Kim K H, Moon D B, Song G W, Jung D H, Park G C, Namgoong J M, Park C S, Park Y H, Park H W, Kang S H, Jung B H, Lee S-G
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2013 Oct;45(8):2997-9. doi: 10.1016/j.transproceed.2013.08.053.
The cosmetic aspects of abdominal skin incisions are a matter of concern for both live liver donors and surgeons. We performed a prospective comparative study on the use of minilaparotomy to perform right liver graft harvests with and without hand-assisted laparoscopic surgery (HALS).
Young donors were indicated for surgery using minilaparotomy with or without HALS. In the non-HALS group (n = 20), a 10-12-cm-long right subcostal incision was used for right liver graft harvest. In the HALS group (n = 20), an 8-cm-sized right subcostal incision was used for hand assistance and 3 laparoscopic holes made for manipulation. The retrohepatic inferior vena cava (IVC) was initially laparoscopically dissected while using air inflation. The skin incision was extended to 10-12 cm, and then hilar dissection and hepatic transection were performed through the skin incision.
In all 40 donors in the study cohort, safe uneventful harvesting of the right liver grafts was successfully achieved through the minilaparotomy incisions. The HALS group required an additional 30 minutes for laparoscopic preparation and dissection compared with the non-HALS group. HALS facilitated retrohepatic IVC dissection, and the remaining part of the surgery was the same as that for minimal-incision surgery. The minimal skin incision for the delivery of the liver from the abdomen was an average 10 cm for grafts <500 g and 12 cm for grafts ≥700 g. Compared with the patient profiles, there were no differences regarding donor age, body mass index, graft weight, intraoperative blood loss, postoperative increase in peak liver enzymes, total hospital stay, and incidence of postoperative complications.
HALS facilitates the performance of donor hepatectomy with the use of a minimal incision, which probably allows for a wider selection of living donors.
腹部皮肤切口的美观问题是活体肝供者和外科医生都关心的问题。我们进行了一项前瞻性对照研究，比较在有或没有手辅助腹腔镜手术（HALS）的情况下，采用小切口剖腹术获取右肝移植物的情况。
选择年轻供者进行有或没有HALS的小切口剖腹术。在非HALS组（n = 20）中，采用10 - 12厘米长的右肋下切口获取右肝移植物。在HALS组（n = 20）中，采用8厘米长的右肋下切口进行手辅助，并制作3个腹腔镜操作孔。最初在充气的情况下通过腹腔镜解剖肝后下腔静脉（IVC）。将皮肤切口延长至10 - 12厘米，然后通过该皮肤切口进行肝门解剖和肝横断术。
在研究队列的所有40例供者中，通过小切口剖腹术成功安全地获取了右肝移植物。与非HALS组相比，HALS组进行腹腔镜准备和解剖需要额外30分钟。HALS有助于肝后IVC的解剖，手术的其余部分与微创切口手术相同。从腹部取出肝脏的最小皮肤切口，对于重量<500克的移植物平均为10厘米，对于重量≥700克的移植物平均为12厘米。与患者资料相比，在供者年龄、体重指数、移植物重量、术中失血、术后肝酶峰值升高、总住院时间和术后并发症发生率方面没有差异。
HALS有助于采用最小切口进行供肝切除术，这可能允许选择更广泛的活体供者。
