Weill Cornell Medicine, New York, NY.
Columbia University Medical Center, New York, NY.
Ann Surg. 2018 Oct;268(4):602-609. doi: 10.1097/SLA.0000000000002959.
In order to minimize the impact of donation, fully laparoscopic donor hepatectomy (LDH) is being investigated at a few centers throughout the world. We report here our experience with 51 living donor pure laparoscopic hepatectomies.
Adoption of minimal access techniques to living donor liver transplantation (LDLT) has been slowed by concerns about donor safety and the quality of the grafts.
Of 344 donor hepatectomies (DHs) for living donor liver transplantation (LDLT) since 1998, 51 pure LDH have been performed since 2009. We report here our experience with 51 living donor pure laparoscopic hepatectomy (LH), based on prospectively collected data. There were 31 left lateral sectionectomy and 20 full lobectomies LH. We matched full lobe LH to open DH prior to introduction of LH.
LH increased from 21% of all DH in first 5 years of performing LH to 45% of DH in the most recent 3 years. Laparoscopic donors were more likely female, had lower body mass index, smaller total livers, and smaller allografts but longer operating room times. In the total LD experience, total 5 donors were converted to open surgery (10%), 2 donors required transfusion (4%), and there was 2 donor bile leaks (4%). Recipient patient and graft 1-year survival was 98% and 94%.
Our experience indicates that LDH for LDLT can be safely used with appropriate attention to learning curve and progression from left lateral sectionectomy to right hepatectomy.
为了将捐献的影响降到最低，全球少数中心正在研究完全腹腔镜供肝切除术（LDH）。我们在此报告我们对 51 例活体供肝纯腹腔镜肝切除术的经验。
由于对供体安全和移植物质量的担忧，微创技术在活体肝移植（LDLT）中的应用进展缓慢。
自 1998 年以来，我们共进行了 344 例供体肝切除术（DHs）用于活体肝移植（LDLT），自 2009 年以来，我们共进行了 51 例纯腹腔镜供肝切除术（LH）。我们在此报告我们对 51 例活体供肝纯腹腔镜肝切除术（LH）的经验，这些数据基于前瞻性收集的数据。有 31 例左外侧叶切除术和 20 例全肝切除术 LH。在引入 LH 之前，我们将全肝 LH 与开放 DH 进行了匹配。
LH 从进行 LH 的前 5 年中所有 DH 的 21%增加到最近 3 年中 DH 的 45%。腹腔镜供体更可能是女性，体重指数较低，总肝较小，移植物较小，但手术时间较长。在整个 LD 经验中，共有 5 名供体转为开放手术（10%），2 名供体需要输血（4%），有 2 名供体胆漏（4%）。受者患者和移植物 1 年存活率为 98%和 94%。
我们的经验表明，LDLT 中的 LDH 可以安全使用，适当注意学习曲线和从左外侧叶切除术到右肝切除术的进展。
