Kim Jane Chungyoon, Hong Suk Kyun, Lee Kwang-Woong, Lee Sola, Suh Sanggyun, Hong Su Young, Han Eui Soo, Choi YoungRok, Yi Nam-Joon, Suh Kyung-Suk
Department of Surgery , Seoul National University College of Medicine , Seoul , South Korea.
Liver Transpl. 2023 Apr 1;29(4):377-387. doi: 10.1002/lt.26564. Epub 2022 Oct 17.
In recent years, laparoscopic techniques for liver resection or living donor hepatectomy have become common surgical methods. However, reports on laparoscopic surgeries for recipients are lacking. Our center has launched the minimally invasive living donor liver transplantation (LDLT) program in March 2020, which is led by two surgeons who are experienced in laparoscopic surgeries. Recently, we reported our first successful pure laparoscopic recipient explant hepatectomy and the first laparoscopic explant hepatectomy and robotic-assisted graft implantation. In this article, we introduce a series of minimally invasive surgical cases that were conducted by a single experienced surgeon to share our early experiences leading to our recent successes. We included 10 cases performed from June 2020 to May 2021 in our initial attempt at laparoscopic explant hepatectomy, graft implantation using midline incision, and robotic-assisted graft implantation surgery. The first four cases required open conversion during the liver mobilization process because of bleeding. The next two cases required open conversion to facilitate portal vein and hepatic artery division. We successfully performed pure laparoscopic explant hepatectomy in the last four cases. For the last case, we attempted to perform graft implantation using a robotic system, but bleeding required open conversion. All patients recovered without any significant acute postoperative problems and were discharged within 2 weeks. All 10 patients were followed up at outpatient clinics, and only one of the 10 patients had a late complication of LDLT. This study has shown that the minimally invasive approach in LDLT may be conducted safely without significant complications if it is performed by highly experienced surgeons working in high-volume centers.
近年来，用于肝切除或活体供肝肝切除术的腹腔镜技术已成为常见的手术方法。然而，关于受体腹腔镜手术的报道却很缺乏。我们中心于2020年3月启动了微创活体肝移植（LDLT）项目，该项目由两位在腹腔镜手术方面经验丰富的外科医生牵头。最近，我们报道了首例成功的单纯腹腔镜受体肝切除手术以及首例腹腔镜肝切除手术和机器人辅助的移植物植入手术。在本文中，我们介绍了由一位经验丰富的外科医生实施的一系列微创手术病例，以分享我们近期取得成功的早期经验。我们纳入了2020年6月至2021年5月期间进行的10例病例，这些病例是我们首次尝试腹腔镜肝切除、经中线切口进行移植物植入以及机器人辅助移植物植入手术。前4例在肝脏游离过程中因出血需要转为开腹手术。接下来的2例需要转为开腹手术以方便门静脉和肝动脉的离断。我们在最后4例中成功实施了单纯腹腔镜肝切除手术。对于最后1例，我们尝试使用机器人系统进行移植物植入，但因出血需要转为开腹手术。所有患者术后均顺利康复，无任何严重的急性术后问题，并在2周内出院。所有10例患者均在门诊进行了随访，10例患者中只有1例出现了LDLT的晚期并发症。这项研究表明，如果由经验丰富的外科医生在大容量中心进行LDLT的微创方法，可能可以安全实施，且无明显并发症。
