Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University.
National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Xi'an Jiaotong University, Xi'an, People's Republic of China.
Int J Surg. 2024 Sep 1;110(9):5483-5488. doi: 10.1097/JS9.0000000000001730.
Some cases of laparoscopic-assisted liver transplantation (LA-LT) with utilization of reduced-size grafts has been reported. The authors here introduced successful utilization of LA-LT with whole liver grafts and magnetic portal vein anastomosis.
Eight patients with liver cirrhosis were included for LA-LT using donor organs after cardiac death. The surgical procedures included purely laparoscopic explant hepatectomy and whole-liver graft implantation via the midline incision. After explant removal, the whole-liver graft was then placed in situ, and a side-to-side cavo-caval anastomosis with 4-5 cm oval opening was performed. The magnetic rings were everted on the donor and recipient portal vein, respectively, and the instant attachment of the two magnets at the donor and recipient portal vein allowed fast blood reperfusion, followed by continuous suturing on the surface of the magnets.
The median operation time was 495 (range 420-630). The median time of explant hepatectomy and inferior vena cava anastomosis was 239 (range 150-300) min and 14.5 (range 10-19) min, respectively. Of note, the median anhepatic time was 25 (range 20-35) min. All the patients were discharged home with no major complications after more than 12 months follow-up.
LA-LT with full-size graft is feasible and utilization of magnetic anastomosis would further simplify the procedure.
已有一些腹腔镜辅助下利用小体积供肝进行肝移植（LA-LT）的病例报道。作者在此介绍了成功应用 LA-LT 进行全肝移植和磁门静脉吻合的经验。
8 例肝硬化患者接受心脏死亡供体的 LA-LT。手术包括纯腹腔镜下供肝切除和经正中切口全肝植入。供肝取出后，原位放置全肝，行侧侧腔静脉-腔静脉吻合，预留 4-5cm 的椭圆形开口。将磁环分别套在供体和受体门静脉上，瞬间吸引供体和受体门静脉，快速恢复血流，然后在磁环表面连续缝合。
中位手术时间为 495 分钟（范围 420-630 分钟）。中位供肝切除和下腔静脉吻合时间分别为 239 分钟（范围 150-300 分钟）和 14.5 分钟（范围 10-19 分钟）。值得注意的是，中位无肝期为 25 分钟（范围 20-35 分钟）。所有患者在 12 个月以上的随访中均无重大并发症出院。
LA-LT 应用全肝体积供肝是可行的，磁吻合的应用进一步简化了手术过程。
