Kakos Christos Dimitrios, Papanikolaou Angelos, Ziogas Ioannis A, Tsoulfas Georgios
Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece.
Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece.
World J Gastrointest Surg. 2023 May 27;15(5):776-787. doi: 10.4240/wjgs.v15.i5.776.
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
微创供体肝切除术（MIDH）是一种相对新颖的手术方法，它有可能提高供体安全性，并有助于供体更快康复。在最初一段时间内，供体安全性未得到有效验证，目前MIDH似乎能取得更好的效果，前提是由经验丰富的外科医生进行操作。合适的选择标准对于在并发症、失血、手术时间和住院时间方面取得更好的结果至关重要。除了单纯的腹腔镜技术外，还推荐了多种方法，如手辅助、腹腔镜辅助和机器人供肝。与开放和腹腔镜方法相比，后者已显示出相同的效果。MIDH似乎存在陡峭的学习曲线，主要是由于肝实质的脆弱性以及充分控制出血所需的经验。本综述探讨了MIDH的挑战与机遇及其全球推广的障碍。外科医生需要具备肝移植、肝胆外科和微创技术方面的专业知识才能进行MIDH。障碍可分为与外科医生相关、与机构相关和可及性方面的障碍。需要更有力的数据并建立国际登记处，以便对该技术进行进一步评估，并获得全球更多中心的认可。
