Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Digestive Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
Surg Endosc. 2017 Dec;31(12):5101-5110. doi: 10.1007/s00464-017-5575-0. Epub 2017 Apr 25.
Although minimally invasive living donor surgery has been increasingly accepted, its safety remains to be fully clarified in a large-scale study. This study evaluated the safety and effectiveness of our laparoscopy-assisted hybrid living donor surgery (LAHDS) procedure with an upper median incision in comparison with conventional open donor hepatectomy (ODH).
From 2011 to 2016, 153 adult living donors [right lobe (RL) graft: 80 donors; left lobe (LL) graft: 73 donors] were enrolled and divided into LAHDS (n = 76) and ODH (n = 77) groups. Donor characteristics, surgical outcomes, and postoperative complications were compared between the 2 groups in each graft subgroup. Postoperative liver function tests (LFTs), inflammatory markers, pain parameters, incision-related symptoms, and recipient outcomes were compared between the 2 groups in all donors.
In RL donors, operative blood loss was significantly lower in the LAHDS group than in the ODH group (201 vs. 313 g; p = 0.034). In LL donors, duration of surgery was significantly longer in the LAHDS group than in the ODH group (459 vs. 403 min; p = 0.034). The incidence of complications, length of hospital stay, and postoperative changes in both LFTs and inflammatory markers were comparable. The incidence of postoperative scar discomfort or tightness was significantly lower in the LAHDS group than in the ODH group (2.6 vs. 31.2%; p < 0.001), whereas postoperative pain parameters were comparable. The incidence of wound problems and abdominal wall numbness tended to be lower, but not significantly so, in the LAHDS group.
This large consecutive case series demonstrates that our LAHDS procedure can be performed as safely as ODH, and it can improve quality of life without impaired donor and recipient outcomes.
尽管微创活体供者手术已被广泛接受，但在大规模研究中仍需充分阐明其安全性。本研究通过与传统的开放性供肝切除术（ODH）相比，评估了我们的腹腔镜辅助杂交活体供者手术（LAHDS）在上部正中切口的安全性和有效性。
2011 年至 2016 年，纳入 153 例成人活体供者[右叶（RL）移植物：80 例；左叶（LL）移植物：73 例]，分为 LAHDS（n=76）和 ODH（n=77）组。比较两组中每组供者的供者特征、手术结果和术后并发症。比较两组中所有供者的术后肝功能检查（LFTs）、炎症标志物、疼痛参数、切口相关症状和受者结果。
RL 供者中，LAHDS 组的手术出血量明显低于 ODH 组（201 比 313g；p=0.034）。LL 供者中，LAHDS 组的手术时间明显长于 ODH 组（459 比 403 分钟；p=0.034）。并发症发生率、住院时间和 LFTs 和炎症标志物的术后变化无差异。LAHDS 组术后疤痕不适或紧绷的发生率明显低于 ODH 组（2.6 比 31.2%；p<0.001），而术后疼痛参数无差异。LAHDS 组的伤口问题和腹壁麻木发生率较低，但无统计学意义。
这项大规模连续病例系列研究表明，我们的 LAHDS 手术可以像 ODH 一样安全进行，并且可以提高生活质量，而不会影响供者和受者的结果。
