Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan.
J Gastrointest Surg. 2021 Oct;25(10):2718-2719. doi: 10.1007/s11605-020-04571-0. Epub 2021 Aug 6.
The use of laparoscopic liver resection (LLR) is widespread owing to its several advantages, especially smaller incision (Kaneko et al., Ann Gastroenterol Surg 1:33-43, 1; Ciria et al., Surg Endosc 34:349-360, 2). However, both posterior sectionectomy and donor hepatectomy are extremely difficult procedures to perform in LLR (Hasegawa et al., Ann Gastroenterol Surg 2:376-382, 3; Soubrane and Kwon, J Hepatobiliary Pancreat Sci 24:E1-E5, 4; Takahara et al., Transplantation 101:1628-1636, 5; Lee et al., Clin Transplant 33:e13683, 6; Hong et al., Surg Endosc 33:3741-3748, 7; Rhu et al., J Hepatobiliary Pancreat Sci 27:16-25, 8). Moreover, the right posterior section graft procurement is also difficult even in open laparotomy procedure (Sugawara et al., Transplantation 73:111-114, 9; Hwang et al., Liver Transpl 10:1150-1155, 10; Hori, Kirino, and Uemoto, Hepatol Res 45:1076-1082, 11; Kusakabe et al., Liver Transpl 26:299-303, 12). The pure laparoscopic donor posterior sectionectomy has not been reported yet. Therefore, we aimed to introduce a novel procedure through a video clip.
The donor was placed in the semi-left lateral decubitus position with the reverse Trendelenburg position using a bean bag device. The right liver was mobilized, and the right hepatic vein was exposed. To adopt the liver hanging maneuver, a tape was inserted between the middle and right hepatic veins along the inferior vena cava. The posterior Glissonean pedicle was encircled and controlled, and the liver parenchyma was completely transected using the liver hanging maneuver. The vessels to the posterior section were respectively isolated. The posterior branches of the hepatic duct, hepatic artery, and portal vein were cut. The right hepatic vein was divided, and the graft liver was retrieved via a suprapubic incision. This study was approved by institutional ethics board (No. MH2019-119), and informed consent was taken from the patient.
The overall surgical time was 503 min, and the blood loss was 400 mL. No complications were observed, and the donor was discharged from the hospital on postoperative day 11.
This is the first report of pure laparoscopic donor hepatectomy of the posterior section graft. This procedure is more difficult than other laparoscopic donor hepatectomies because it involves parenchymal transection in the right intersectional plane and dissection of the posterior branches of hilar vessels.
由于腹腔镜肝切除术（LLR）具有许多优势，尤其是较小的切口（Kaneko 等人，Ann Gastroenterol Surg 1:33-43,1；Ciria 等人，Surg Endosc 34:349-360,2），因此其应用广泛。然而，后叶切除术和供肝切除术在 LLR 中都非常困难（Hasegawa 等人，Ann Gastroenterol Surg 2:376-382,3；Soubrane 和 Kwon，J Hepatobiliary Pancreat Sci 24:E1-E5,4；Takahara 等人，Transplantation 101:1628-1636,5；Lee 等人，Clin Transplant 33:e13683,6；Hong 等人，Surg Endosc 33:3741-3748,7；Rhu 等人，J Hepatobiliary Pancreat Sci 27:16-25,8）。此外，即使在开腹手术中，右后叶供体肝段的获取也很困难（Sugawara 等人，Transplantation 73:111-114,9；Hwang 等人，Liver Transpl 10:1150-1155,10；Hori、Kirino 和 Uemoto，Hepatol Res 45:1076-1082,11；Kusakabe 等人，Liver Transpl 26:299-303,12）。纯腹腔镜供体后叶切除术尚未有报道。因此，我们旨在通过视频剪辑介绍一种新的手术方法。
供体取半左侧卧位，采用反特伦德伦堡体位，使用豆袋装置。游离右肝，显露肝右静脉。为采用肝悬挂术，在肝中静脉和右肝静脉之间沿下腔静脉插入一条带子。环绕后叶 Glisson 蒂并控制，使用肝悬挂术完全切断肝实质。分别分离至后叶的血管。切断肝后支胆管、肝动脉和门静脉。切断肝右静脉，通过耻骨上切口取出供体肝。本研究得到机构伦理委员会的批准（编号：MH2019-119），并获得患者同意。
总手术时间为 503 分钟，出血量为 400 毫升。无并发症发生，供体于术后第 11 天出院。
这是首例纯腹腔镜供体后叶切除术的报道。由于涉及右交界平面的实质切开和肝门血管后支的解剖，该手术比其他腹腔镜供体肝切除术更困难。
