Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea.
Department of General SurgeryDigestive Disease & Surgery InstituteLerner College of MedicineCleveland ClinicClevelandOhioUSA.
Liver Transpl. 2022 Jul;28(7):1158-1172. doi: 10.1002/lt.26429. Epub 2022 Jun 5.
This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p < 0.001) and transition period (48.1% vs. 24.3%; p < 0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p = 0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p = 0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p = 0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p < 0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p < 0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p < 0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p = 0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.
本研究旨在回顾一家中心从开放手术完全过渡到腹腔镜的腹腔镜活体肝移植（LDLT）。回顾了 2013 年 1 月至 2021 年 7 月期间进行的 LDLT。根据分为初始、过渡和完全过渡三个阶段的时期，对开放手术和腹腔镜手术进行了比较。共进行了 775 例 LDLT，其中 506 例腹腔镜和 269 例开放手术。2020 年实现了完全过渡。在初始阶段（30.2%比 8.1%；p<0.001）和过渡阶段（48.1%比 24.3%；p<0.001），开放组的胆管变异明显更为丰富。仅在初始阶段，门静脉变异在开放组更为丰富（13.0%比 4.1%；p=0.03）。虽然在初始阶段，腹腔镜组的供体再手术率（0.0%比 4.1%；p=0.02）和 III 级或更高并发症率（5.6%比 13.5%；p=0.03）明显更高，但在过渡阶段以及所有病例中均无差异。供体所需阿片类药物的中位数（3 次[四分位距 IQR，1-6]比 1 次[IQR，0-3]；p<0.001）较低，且腹腔镜组的中位住院时间（10 天[IQR，8-12]比 8 天[IQR，7-9]；p<0.001）较短。腹腔镜组的总受体胆漏率（23.8%比 12.8%；p<0.001）和总 III 级或更高并发症率（44.6%比 37.2%；p=0.009）明显较低。在积累了大量经验后，完全过渡到腹腔镜活体供肝切除术是可能的。由于在初始阶段供体发病率可能更高，因此需要为供体和受体选择具有良好解剖结构的供体。
