Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris and University of Paris, France.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Ann Surg. 2022 Jan 1;275(1):166-174. doi: 10.1097/SLA.0000000000003852.
Evaluating the perioperative outcomes of minimally invasive (MIV) donor hepatectomy for adult live donor liver transplants in a large multi-institutional series from both Eastern and Western centers.
Laparoscopic liver resection has become standard practice for minor resections in selected patients in whom it provides reduced postoperative morbidity and faster rehabilitation. Laparoscopic approaches in living donor hepatectomy for transplantation, however, remain controversial because of safety concerns. Following the recommendation of the Jury of the Morioka consensus conference to address this, a retrospective study was designed to assess the early postoperative outcomes after laparoscopic donor hepatectomy. The collective experience of 10 mature transplant teams from Eastern and Western countries was reviewed.
All centers provided data from prospectively maintained databases. Only left and right hepatectomies performed using a MIV technique were included in this study. Primary outcome was the occurrence of complications using the Clavien-Dindo graded classification and the Comprehensive Complication Index during the first 3 months. Logistic regression analysis was used to identify risk factors for complications.
In all, 412 MIV donor hepatectomies were recorded including 164 left and 248 right hepatectomies. Surgical technique was either pure laparoscopy in 175 cases or hybrid approach in 237. Conversion into standard laparotomy was necessary in 17 donors (4.1%). None of the donors died. Also, 108 experienced 121 complications including 9.4% of severe (Clavien-Dindo 3-4) complications. Median Comprehensive Complication Index was 5.2.
This study shows favorable early postoperative outcomes in more than 400 MIV donor hepatectomy from 10 experienced centers. These results are comparable to those of benchmarking series of open standard donor hepatectomy.
在来自东西方中心的大型多机构系列中，评估微创（MIV）供体肝切除术在成人活体供肝移植中的围手术期结果。
腹腔镜肝切除术已成为某些患者中进行小部分切除的标准方法，因为它可以降低术后发病率并加快康复。然而，由于安全性问题，腹腔镜在活体供肝切取中的应用仍存在争议。为了解决这个问题，根据盛冈共识会议评审团的建议，进行了一项回顾性研究，以评估腹腔镜供体肝切除术后的早期术后结果。回顾了来自东西方 10 个成熟移植团队的集体经验。
所有中心均从前瞻性维护的数据库中提供数据。仅包括使用 MIV 技术进行的左肝和右肝切除术。本研究的主要结果是使用 Clavien-Dindo 分级分类和综合并发症指数在术后 3 个月内发生并发症的情况。使用逻辑回归分析确定并发症的危险因素。
共记录了 412 例 MIV 供体肝切除术，其中包括 164 例左肝切除术和 248 例右肝切除术。手术技术要么是纯腹腔镜手术，要么是混合方法，分别有 175 例和 237 例。17 例供体需要转为标准剖腹手术（4.1%）。没有供体死亡。108 例供体共发生 121 例并发症，其中 9.4%为严重并发症（Clavien-Dindo 3-4 级）。综合并发症指数中位数为 5.2。
这项研究显示，在 10 个经验丰富的中心进行的 400 多例 MIV 供体肝切除术中，术后早期结果良好。这些结果与基准开放标准供体肝切除术的系列结果相当。
