Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of General Surgery, Digestive Disease and Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Br J Surg. 2020 Feb;107(3):278-288. doi: 10.1002/bjs.11350. Epub 2019 Oct 25.
The feasibility and learning curve of laparoscopic living donor right hepatectomy was assessed.
Donors who underwent right hepatectomy performed by a single surgeon were reviewed. Comparisons between open and laparoscopy regarding operative outcomes, including number of bile duct openings in the graft, were performed using propensity score matching.
From 2014 to 2018, 103 and 96 donors underwent laparoscopic and open living donor right hepatectomy respectively, of whom 64 donors from each group were matched. Mean(s.d.) duration of operation (252·2(41·9) versus 304·4(66·5) min; P < 0·001) and median duration of hospital stay (8 versus 10 days; P = 0·002) were shorter in the laparoscopy group. There was no difference in complication rates of donors (P = 0·298) or recipients (P = 0·394) between the two groups. Total time for laparoscopy decreased linearly (R = 0·407, β = -0·914, P = 0·001), with the decrease starting after approximately 50 procedures when cases were divided into four quartiles (2nd versus 3rd quartile, P = 0·001; 3rd versus 4th quartile, P = 0·023). Although grafts with bile duct openings were more abundant in the laparoscopy group (P = 0·022), no difference was found in the last two quartiles (P = 0·207).
Laparoscopic living donor right hepatectomy is feasible and an experience of approximately 50 cases may surpass the learning curve.
评估了腹腔镜活体右肝切除术的可行性和学习曲线。
回顾了由一名外科医生进行的右肝切除术供者。使用倾向评分匹配比较了开腹手术和腹腔镜手术在手术结果方面的差异，包括移植物中胆管开口的数量。
2014 年至 2018 年，分别有 103 名和 96 名供者接受了腹腔镜和开腹活体右半肝切除术，每组有 64 名供者匹配。腹腔镜组手术时间（252.2(41.9)分钟比 304.4(66.5)分钟；P<0.001）和中位住院时间（8 天比 10 天；P=0.002）较短。两组供者（P=0.298）或受者（P=0.394）的并发症发生率无差异。腹腔镜总时间呈线性下降（R2=0.407，β=-0.914，P=0.001），当将病例分为四个四分位数时，下降始于大约 50 例之后（第 2 四分位数与第 3 四分位数相比，P=0.001；第 3 四分位数与第 4 四分位数相比，P=0.023）。虽然腹腔镜组胆管开口较多（P=0.022），但在后两个四分位数中差异无统计学意义（P=0.207）。
腹腔镜活体右肝切除术是可行的，大约 50 例的经验可能超过学习曲线。
