Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Ann Transplant. 2021 Nov 5;26:e933371. doi: 10.12659/AOT.933371.
BACKGROUND Hepatic artery reconstruction during living donor liver transplantation is a critical step. To perform this risky procedure, a microscope has been used. However, it takes a long time to complete the procedure and it has a long and steep learning curve. Recently, some transplant surgeons have performed the procedure using a surgical loupe. We conducted this study to compare the outcomes after hepatic artery reconstruction using a microscope versus using a surgical loupe. MATERIAL AND METHODS We retrospectively reviewed the outcomes of 300 patients at our institution from April 2014 to July 2020. From April 2014 to September 2017 (era 1), hepatic artery reconstruction was performed using a microscope by an experienced plastic surgeon. From September 2017 to the end date (era 2), it was performed using a loupe (×5.0) by an experienced transplantation surgeon. RESULTS There was no difference in most perioperative outcomes between the 2 groups, including the major postoperative complications of hepatic artery complications (2/150 versus 2/150, P=1.000), postoperative bleeding (10/150 versus 5/150, P=0.185), and biliary leakage (18/150 versus 13/150, P=0.343). There was a statistically significant difference between the 2 groups in anastomosis time (42.4±11.8 versus 24.2±7.8, P<0.001) and the entire operation time (436.6±83.9 versus 415.3±68.5, P=0.035). CONCLUSIONS We suggest that when the surgeon is familiar with a loupe and vascular anastomosis, hepatic artery reconstruction using a surgical loupe is a safe and feasible method with a shorter operation time.
肝动脉重建是活体肝移植过程中的关键步骤。为了完成这一有风险的手术，显微镜已被广泛使用。然而，手术过程耗时较长，并且具有陡峭的学习曲线。最近，一些移植外科医生已经使用手术放大镜来完成该手术。我们进行这项研究旨在比较使用显微镜和手术放大镜进行肝动脉重建的结果。
我们回顾性分析了 2014 年 4 月至 2020 年 7 月在我院接受治疗的 300 例患者的资料。从 2014 年 4 月至 2017 年 9 月（时代 1），肝动脉重建由一位经验丰富的整形外科医生使用显微镜完成。从 2017 年 9 月至截止日期（时代 2），由一位经验丰富的移植外科医生使用手术放大镜（×5.0）完成。
两组患者的大多数围手术期结果均无差异，包括肝动脉并发症的主要术后并发症（2/150 与 2/150，P=1.000）、术后出血（10/150 与 5/150，P=0.185）和胆漏（18/150 与 13/150，P=0.343）。在吻合时间（42.4±11.8 与 24.2±7.8，P<0.001）和整个手术时间（436.6±83.9 与 415.3±68.5，P=0.035）方面，两组之间存在统计学显著差异。
当外科医生熟悉手术放大镜和血管吻合时，使用手术放大镜进行肝动脉重建是一种安全可行的方法，手术时间更短。
