Papoulas Michail, Hakeem Abdul Rahman, Heaton Nigel, Menon Krishna V
Department of Institute of Liver Studies, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
Department of Hepatobiliary and Liver Transplantation, St. James's University Hospital NHS Trust, Leeds, UK.
J Minim Access Surg. 2022 Jan-Mar;18(1):1-11. doi: 10.4103/jmas.JMAS_103_21.
Pure laparoscopic donor hepatectomy (PLDH) for adult living donor liver transplantation (LDLT) remains controversial. The aim of this study was to undertake a systematic review and meta-analysis of donor outcomes following PLDH for adult LDLT.
Systematic review in line with the meta-analysis of observational studies in epidemiology guidelines.
Eight studies were included in the systematic review and six in the meta-analysis. A total of 575 donors underwent PLDH for adult LDLT. The mean donor age was 32.8 years with a BMI of 23.4 kg/m and graft weight of 675 g. The mean operative time was 353 min and the conversion rate was 2.8% (n = 16). Overall morbidity was 10.8% with 1.6% major complications (Clavien-Dindo grade 3b), zero mortality and 9.0 days length of stay (LOS). The meta-analysis demonstrated that the operative time was significantly shorter for the open donor hepatectomy group (mean difference 29.15 min; P = 0.006) and the LOS was shorter for the PLDH group (mean difference -0.73 days; P = 0.02), with a trend towards lesser estimated blood loss in PLDH group. However, no difference between the two groups was noted in terms of overall morbidity or major complications.
Perioperative outcomes of PLDH are similar to the standard open approach in highly specialised centers with trend towards lesser blood loss and overall shorter hospital stay. Careful donor selection and standardisation of the technique are imperative for the successful implementation and adoption of the procedure worldwide.
成人活体肝移植（LDLT）的单纯腹腔镜供体肝切除术（PLDH）仍存在争议。本研究的目的是对成人LDLT行PLDH后的供体结局进行系统评价和荟萃分析。
按照流行病学观察性研究荟萃分析指南进行系统评价。
系统评价纳入8项研究，荟萃分析纳入6项研究。共有575例供体接受了成人LDLT的PLDH。供体平均年龄为32.8岁，体重指数为23.4kg/m，移植物重量为675g。平均手术时间为353分钟，中转率为2.8%（n = 16）。总体发病率为10.8%，严重并发症发生率为1.6%（Clavien-Dindo 3b级），无死亡病例，住院时间为9.0天。荟萃分析表明，开放供体肝切除组的手术时间明显更短（平均差值29.15分钟；P = 0.006），PLDH组的住院时间更短（平均差值-0.73天；P = 0.02），PLDH组估计失血量有减少趋势。然而，两组在总体发病率或严重并发症方面无差异。
在高度专业化的中心，PLDH的围手术期结局与标准开放手术相似，有失血量减少和总体住院时间缩短的趋势。仔细的供体选择和技术标准化对于该手术在全球的成功实施和应用至关重要。
