Lee Boram, Choi YoungRok, Han Ho-Seong, Yoon Yoo-Seok, Cho Jai Young, Kim Sungho, Kim Kil Hwan, Hyun In Gun
Department of Surgery, College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Seongnam, South Korea.
Clin Transplant. 2019 Oct;33(10):e13683. doi: 10.1111/ctr.13683. Epub 2019 Aug 27.
This study aims to compare the early outcomes between pure laparoscopic living donor right hepatectomy (PLDRH) and open living donor right hepatectomy (ODRH) after those learning curve. Our analysis was based on 78 consecutive cases of living liver donor, who underwent right hepatectomy, of which 43 underwent ODRH and 35 PLDRH. The learning curve for each group was analyzed. Donor characteristics were comparable between the two groups. Two donors in the PLDRH required conversion to an open due to bleeding and large graft size (open conversion rate: 6.06%). The following outcomes during the study period were comparable between the two groups: operative time (P = .64); estimated blood loss (EBL; P = .86); intra-operative transfusion (P = .57); hospital stay (P = .41); and postoperative complications (P = .51). The operative time stabilized for the ODRH group after 17 cases and for the PLDRH group after 15 cases. After the learning curve, the EBL was lower for PLDRH than ODRH (P = .04). Pure laparoscopic living donor right hepatectomy can be performed as safely as ODRH and with a lower volume of EBL once the surgeon has attained an appropriate level of learning.
本研究旨在比较纯腹腔镜活体供体右半肝切除术（PLDRH）和开放活体供体右半肝切除术（ODRH）度过学习曲线后的早期结果。我们的分析基于78例连续接受右半肝切除术的活体肝供体病例，其中43例行ODRH，35例行PLDRH。分析了每组的学习曲线。两组的供体特征具有可比性。PLDRH组中有2例因出血和移植物体积大而转为开放手术（开放转换率：6.06%）。在研究期间，两组的以下结果具有可比性：手术时间（P = 0.64）；估计失血量（EBL；P = 0.86）；术中输血（P = 0.57）；住院时间（P = 0.41）；以及术后并发症（P = 0.51）。ODRH组在17例手术后手术时间稳定，PLDRH组在15例手术后稳定。度过学习曲线后，PLDRH的EBL低于ODRH（P = 0.04）。一旦外科医生达到适当的学习水平，纯腹腔镜活体供体右半肝切除术可以与ODRH一样安全地进行，且EBL量更低。
