Lee Soo Kyung, Han Young Seok, Ha Heontak, Han Jaryung, Chun Jae Min
Liver Transplantation and Hepatobiliary Pancreas Surgery, Department of Surgery, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
J Minim Invasive Surg. 2019 Jun;22(2):61-68. doi: 10.7602/jmis.2019.22.2.61. Epub 2019 Jun 15.
Donor safety is the most important problem of living donor liver transplantation (LDLT). Although laparoscopic liver resection has gained popularity with increased surgical experience and the development of laparoscopes and specialized instruments, a totally laparoscopic living donor right hepatectomy (LDRH) technique has not been investigated for efficacy and feasibility. We describe the experiences and outcomes associated with LDRH in adult-to-adult LDLT in order to assess the safety of the totally laparoscopic technique in donors.
Between May 2016 and July 2017, we performed hepatectomies in 22 living donors using a totally laparoscopic approach. Among them, 20 donors underwent LDRH. We retrospectively reviewed the medical records to ascertain donor safety and the reproducibility of LDRH; intra-operative and post-operative results including complications were demonstrated after performing LDRH.
The median donor age was 29 years old and the median body mass index was 22.6 kg/m. The actual graft weight was 710 g and graft weight/body weight (GRWR) was 1.125. No donors required blood transfusion, conversion to open surgery, or reoperation. The postoperative mortality was nil and postoperative complications were identified in two donors. One had fluid collection in the supra-pubic incision site for graft retrieval and the second had a minor bile leakage from the cutting edge of the right hepatic duct stump. All the liver function tests returned to normal ranges within one month.
LDRH is a feasible operation owing to low blood loss and few complications. However, LDRH can be initially attempted after attaining sufficient experience in laparoscopic hepatectomy and LDLT techniques.
供体安全是活体肝移植（LDLT）最重要的问题。尽管随着手术经验的增加以及腹腔镜和专用器械的发展，腹腔镜肝切除术越来越普及，但完全腹腔镜活体供体右半肝切除术（LDRH）技术的有效性和可行性尚未得到研究。我们描述了成人对成人LDLT中LDRH的经验和结果，以评估完全腹腔镜技术在供体中的安全性。
2016年5月至2017年7月期间，我们采用完全腹腔镜方法对22名活体供体进行了肝切除术。其中，20名供体接受了LDRH。我们回顾性审查了病历，以确定供体安全性和LDRH的可重复性；在进行LDRH后展示了术中及术后结果，包括并发症。
供体年龄中位数为29岁，体重指数中位数为22.6kg/m。实际移植物重量为710g，移植物重量/体重（GRWR）为1.125。没有供体需要输血、转为开放手术或再次手术。术后死亡率为零，两名供体出现术后并发症。一名在耻骨上切口部位有积液用于取出移植物，另一名右肝管残端切缘有少量胆漏。所有肝功能检查在1个月内恢复到正常范围。
由于失血少且并发症少，LDRH是一种可行的手术。然而，在获得足够的腹腔镜肝切除术和LDLT技术经验后，可首先尝试LDRH。
