The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
Pediatr Transplant. 2022 Feb;26(1):e14110. doi: 10.1111/petr.14110. Epub 2021 Aug 12.
LT for infants less than 5 kg remains a challenge with high technical complication rates, which is further compounded by large-for-size grafts requiring hyper-reduction. The benefits of MIDH especially for standard left lateral segment (LLS) resection have been unequivocally demonstrated. However, given the fine margins of error, the highly challenging technical aspects of anatomical graft reduction test the limits of safety and may not be routinely feasible with the conventional laparoscopic approach.
A 14-month-old girl weighing 4.4 kg with extrahepatic biliary atresia was referred to our unit for an LT. Her mother volunteered to donate and the calculated volume of the LLS was 342 ml, with an estimated GRWR of 7.6. Given the extremely high GRWR, a segment II monosegment graft was planned. A RMDH was performed, with a final GRWR of 4. The donor and recipient were discharged on the 5th and 12th post-operative days, respectively.
We present the first-ever report of an RMDH. Our report highlights the fact that robotic surgery can safely replicate a highly precise surgical operation, thereby safely pushing the limits of MIDH.
对于体重小于 5 公斤的婴儿，LT 仍然具有挑战性，技术并发症发生率高，特别是对于体积较大的移植物需要进行超减容。MIDH 的益处，特别是对于标准左外侧段（LLS）切除，已经得到了明确的证明。然而，由于误差幅度很小，解剖性移植物还原测试的高度挑战性技术方面超出了安全性的极限，并且可能不适用于常规腹腔镜方法。
一名 14 个月大、体重 4.4 公斤的婴儿患有肝外胆管闭锁，被转介到我们单位进行 LT。她的母亲自愿捐献，计算出的 LLS 体积为 342ml，预计 GRWR 为 7.6。鉴于极高的 GRWR，计划进行 II 段单段移植物。进行了 RMDH，最终 GRWR 为 4。供体和受体分别在术后第 5 天和第 12 天出院。
我们首次报告了 RMDH。我们的报告强调了机器人手术可以安全地复制高度精确的手术操作，从而安全地推动 MIDH 的极限。
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