Ju Man Ki, Yoo Sung Hwan, Choi Ki Hong, Yoon Dong Sub, Lim Jin Hong
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Liver Clinic, Gangnam Severance Hospital, Seoul, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Liver Clinic, Gangnam Severance Hospital, Seoul, South Korea.
Asian J Surg. 2024 Jan;47(1):354-359. doi: 10.1016/j.asjsur.2023.08.227. Epub 2023 Oct 6.
Pure laparoscopic donor hepatectomy (PLDH) is an increasingly performed procedure despite its technical difficulties. This study introduced a selective liver parenchymal hanging maneuver and rubber band retraction technique for PLDH.
We retrospectively reviewed perioperative data from 58 patients who underwent donor right hepatectomy (including right extended) between March 2009 and February 2021. Eighteen patients underwent open donor right hepatectomy (ODRH) and 38 patients underwent pure laparoscopic donor right hepatectomy (PLDRH).
All PLDRH donors underwent the procedure without the need for open conversion. The median PLDRH operative time was 396.84 ± 72.459 min, the median PLDRH intraoperative bleeding amount was 496.05 ± 272.591 ml, and the warm ischemic time was 8.77 ± 3.062 min. Compared to ODRH, laparoscopic surgery showed further advantages in terms of postoperative hospital stay (10.94 ± 4.036 days vs. 8.03 ± 2.646 days, respectively, P = 0.01) and estimated blood loss (676.67 ± 321.046 ml vs. 496.05 ± 272.591 ml, respectively, P = 0.033).
The selective liver parenchymal hanging maneuver and rubber band retraction technique is a simple and effective pure laparoscopic procedure for donor hepatectomy. Our results demonstrate the safety and feasibility of this technique.
尽管存在技术难题，但单纯腹腔镜供肝切除术（PLDH）的开展越来越多。本研究介绍了一种用于PLDH的选择性肝实质悬吊操作和橡皮筋牵拉技术。
我们回顾性分析了2009年3月至2021年2月期间接受供体右半肝切除术（包括右半肝扩大切除术）的58例患者的围手术期数据。18例患者接受了开放性供体右半肝切除术（ODRH），38例患者接受了单纯腹腔镜供体右半肝切除术（PLDRH）。
所有PLDRH供体均无需中转开腹完成手术。PLDRH的中位手术时间为396.84±72.459分钟，中位术中出血量为496.05±272.591毫升，热缺血时间为8.77±3.062分钟。与ODRH相比，腹腔镜手术在术后住院时间（分别为10.94±4.036天和8.03±2.646天，P = 0.01）和估计失血量（分别为676.67±321.046毫升和496.05±272.591毫升，P = 0.033）方面显示出更大优势。
选择性肝实质悬吊操作和橡皮筋牵拉技术是一种简单有效的单纯腹腔镜供肝切除术。我们的结果证明了该技术的安全性和可行性。
