Department of Surgery Seoul National University HospitalSeoul National University College of Medicine Seoul Republic of Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea Department of SurgerySchool of Medicine Kyungpook National University, Kyungpook, National University Hospital Daegu Republic of Korea Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea Department of Surgery Seoul National University Bundang HospitalSeoul National University College of Medicine Seoul Republic of Korea Department of Surgery, Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH.
Liver Transpl. 2021 Jan;27(1):67-76. doi: 10.1002/lt.25848. Epub 2020 Sep 5.
According to recent international consensus conferences, pure laparoscopic donor hepatectomy (PLDH), particularly right and left hepatectomies, is not yet considered a standard practice because studies remain limited. Thus, we present the outcomes of more than 500 PLDH patients, mostly receiving a right hepatectomy. To our knowledge, this is the largest study to date on PLDH. Data from all living liver donors who underwent PLDH at 5 centers in Korea until June 2018 were retrospectively analyzed. The outcomes of both donors and recipients were included. Pearson correlation analysis was used to explore the relationship between the duration of surgery and cumulative experience at each center, which reflects the learning curve. Overall, 545 PLDH cases were analyzed, including 481 right hepatectomies, 25 left hepatectomies, and 39 left lateral sectionectomies (LLS). The open conversion was necessary for 10 (1.8%) donors, and none of the donors died or experienced irreversible disability. Notably, there were 25 (4.6%) patients with major complications (higher than Clavien-Dindo grade 3). All centers except one showed a significant decrease in surgery duration as the number of cases accumulated. Regarding recipient outcomes, there were 110 cases (20.2%) of early major complications and 177 cases (32.5%) of late major complications. This study shows the early and late postoperative outcomes of 545 donors and corresponding recipients, including 481 right hepatectomies and 25 left hepatectomies, from 5 experienced centers. Although the results are comparable to those of previously reported open donor hepatectomy series, further studies are needed to consider PLDH a new standard practice.
根据最近的国际共识会议，纯腹腔镜供肝切除术（PLDH），特别是右肝和左肝切除术，尚未被认为是一种标准实践，因为研究仍然有限。因此，我们报告了 500 多例 PLDH 患者的结果，其中大多数接受了右肝切除术。据我们所知，这是迄今为止关于 PLDH 的最大研究。回顾性分析了韩国 5 个中心在 2018 年 6 月前接受 PLDH 的所有活体肝供者的数据。包括供者和受者的结果。采用皮尔逊相关分析探讨手术时间与每个中心累计经验之间的关系，这反映了学习曲线。总的来说，分析了 545 例 PLDH 病例，包括 481 例右肝切除术、25 例左肝切除术和 39 例左外侧段切除术（LLS）。有 10 名（1.8%）供者需要开放转换，没有供者死亡或出现不可逆转的残疾。值得注意的是，有 25 名（4.6%）患者发生严重并发症（高于 Clavien-Dindo 分级 3）。除一个中心外，所有中心的手术时间都随着病例数的增加而显著减少。关于受者的结果，有 110 例（20.2%）早期主要并发症和 177 例（32.5%）晚期主要并发症。本研究显示了 5 个经验丰富的中心的 545 名供者和相应受者的早期和晚期术后结果，包括 481 例右肝切除术和 25 例左肝切除术。尽管结果与以前报道的开放供肝切除术系列相似，但需要进一步研究将 PLDH 视为一种新的标准实践。
