Division of Liver Transplantation and Hepato-Biliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, OlympicRo 43-Gil,Songpa-gu, Seoul, 138-736, Korea.
Division of Hepatobiliary and Liver Transplantation, Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Surg Endosc. 2018 Jan;32(1):513. doi: 10.1007/s00464-017-5692-9. Epub 2017 Jul 17.
Minimally invasive surgery has been validated to be a new standard in living donor hepatectomy for adult-to-pediatric transplantation with less morbidity [1]. Laparoscopic donor hepatectomy can reduce the major concerns about pain and morbidity associated with open surgery and a slow return to daily activities of donors [2]. Herein, we present one case of totally laparoscopic living donor left hepatectomy including the middle hepatic vein (MHV).
A 37-year-old mother volunteered to donate to her 3-year-old son with biliary atresia (PELD score 7). Total donor liver volume was 833 cm and left liver, including MHV, was 290 cm. Graft to recipient body weight ratio was 2.07. Our operative technique has been published previously [2]. The left hepatic artery and portal vein were dissected and encircled with two vessel loops. Pringle's maneuver was used during parenchymal transection. The transection of the liver was performed using an alternating combination of laparoscopic ultrasonic aspirator (CUSA) and THUNDERBEAT™ (Olympus, Japan). The MHV was identified and parenchymal transection was performed right side to it. Several small tributaries from segment V and VIII were identified and divided. Finally, left bile duct was identified and divided after performing intraoperative cholangiography using a mobile C-arm.
Totally laparoscopic living donor left hepatectomy was performed successfully without intraoperative complications and transfusion. The operation time was 300 min, the estimated blood loss was less than 125 ml and Graft weight was 314 g. Oral intake was resumed on the first postoperative day (POD). On POD 4, CT scan showed no pathological findings. The patient was discharged on POD 8 without complications.
The authors conclude that the laparoscopic living donor left hepatectomy is a safe and feasible procedure but should be performed in selected patients with a favorable anatomy.
微创外科已被验证为成人到儿童肝移植活体供肝切除术的新标准，具有较低的发病率[1]。腹腔镜供肝切除术可以减少与开放性手术相关的主要疼痛和发病率问题，并使供体更快地恢复日常活动[2]。在此，我们报告了一例完全腹腔镜活体左半肝切除术，包括中肝静脉（MHV）。
一位 37 岁的母亲自愿为患有胆道闭锁的 3 岁儿子（PELD 评分 7）捐献。供体总肝体积为 833cm，左肝包括 MHV 为 290cm。供体与受体体重比为 2.07。我们的手术技术以前已经发表过[2]。游离左肝动脉和门静脉，用双血管套环套住。肝实质切开时使用普雷尔氏操作。肝实质的切开采用腹腔镜超声吸引器（CUSA）和 THUNDERBEAT™（奥林巴斯，日本）交替组合进行。识别出 MHV，在其右侧进行肝实质切开。识别出来自第五段和第八段的几个小分支并予以分离。最后，在使用移动 C 臂进行术中胆管造影后，识别出左胆管并予以分离。
完全腹腔镜活体左半肝切除术成功完成，无术中并发症和输血。手术时间为 300 分钟，估计出血量少于 125ml，移植物重量为 314g。术后第一天（POD）开始口服。POD4 时 CT 扫描未见异常。患者无并发症于 POD8 出院。
作者认为腹腔镜活体左半肝切除术是一种安全可行的手术，但应在具有良好解剖结构的选定患者中进行。
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