Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain.
Department of General and Digestive Surgery, Torrevieja University Hospital, Alicante, Spain.
Updates Surg. 2023 Jun;75(4):807-816. doi: 10.1007/s13304-023-01506-7. Epub 2023 Apr 4.
The minimally invasive approach (MIS) is undoubtedly one of the most important breakthroughs in surgery in recent decades. Consequently, MIS has been increasingly in the field of liver transplantation (LT). The objective of the present review was to determine the current status of MIS with respect to liver transplantation (LT) and what would be the indications for an MIS in this context today. The literature was searched for publications reporting the MIS in LT. Only those articles that described the results according to whether the MIS had been performed to treat transplant complications (urgent or late), another pathology not related to the LT, or to perform the liver explantation and graft implantation were included. From 2000 to 2022, 33 studies and 261 patients were included. Most frequent indications were incisional hernias secondary to LT followed by the treatment of other pathologies not related with the LT and treatment of LT complications. Only a 12% were urgent interventions. Few studies describe conversions with an average rate of 2.5%. Morbidity do not differ significantly from open surgery. No case of mortality or graft loss was described. Purely laparoscopic liver explants in 9 patients with 2 conversions and 3 cases of graft implantation with a higher warm ischemia in the MIS implants grafts were described. The limitations of MIS in LT are relative and probably depend more on training, experience, and skills of the surgeons. This approach could be safety and feasibility to solved complications or in other individualized indications in LT patients. The initial experiences in liver explant and graft implantation need further investigations.
微创手术（MIS）无疑是近几十年来外科领域最重要的突破之一。因此，MIS 在肝移植（LT）领域得到了越来越多的应用。本综述的目的是确定 MIS 在肝移植（LT）方面的现状，以及在当前背景下，MIS 的适应证是什么。我们对报道 LT 中 MIS 的文献进行了检索。仅纳入那些根据 MIS 是否用于治疗移植并发症（紧急或晚期）、与 LT 无关的其他病理学或进行肝切除和移植物植入来描述结果的文章。2000 年至 2022 年，共纳入 33 项研究和 261 例患者。最常见的适应证是 LT 后切口疝，其次是治疗与 LT 无关的其他疾病和 LT 并发症。只有 12%的是紧急干预。少数研究报告了转换病例，平均转化率为 2.5%。发病率与开放手术无显著差异。未描述死亡或移植物丢失病例。9 例患者进行了纯腹腔镜肝切除，其中 2 例发生了转换，3 例进行了移植，MIS 植入物的热缺血时间较长。LT 中 MIS 的局限性是相对的，可能更多地取决于外科医生的培训、经验和技能。这种方法在解决 LT 患者的并发症或其他个体化适应证方面可能是安全且可行的。肝切除和移植物植入的初步经验需要进一步研究。
