Faculty Collaboration Database

Laparoscopy-assisted donor right hepatectomy using a hand port system preserving the middle hepatic vein branches. World J Surg 2009 Mar;33(3):526-33

Date

12/31/2008

Pubmed ID

19115031

DOI

10.1007/s00268-008-9842-z

Scopus ID

2-s2.0-60449118848 (requires institutional sign-in at Scopus site)   52 Citations

Abstract

BACKGROUND: This report reviews our experience with a modified right hepatectomy (MRH) using laparoscopic or laparoscopy-assisted techniques preserving the middle hepatic vein (MHV) branches in living donor liver transplantation.

METHODS: Nine female donors (17-36 years) underwent a laparoscopic MRH under pneumoperitoneum (L-MRH; n = 2) or a laparoscopy-assisted MRH (LA-MRH; n = 7) with a hand port device. The donors for this minimally invasive surgery were volunteers with the willingness to undergo laparoscopic surgery and recipients who were not in urgent need of transplantation. Mobilization of the right liver was performed under pneumoperitoneum in all cases. Hilar dissection and parenchymal transection were performed under pneumoperitonuem (n = 2) or with a mini-laparotomy incision (n = 7) using an ultrasonic aspirator without the Pringle maneuver. The major MHV branches (>5 mm) were preserved using Hem-o-lock clips. The graft was extracted through the site of the hand port device or the mini-laparotomy. On the back table, the MHV branches were reconstructed with an artificial vascular graft.

RESULTS: There were no open conversions, and the graft was transplanted without any problem in every case. The operative time for the donors was 765 min and 898 min in the L-MRH patients, and it ranged from 310 to 575 min for the laparoscopy-assisted surgery. None of the donors required transfusion or reoperation; they were discharged on postoperative day 8-14 with normal liver function. A major complication occurred in one donor; fluid collection along the liver resection margin with fever was treated and resolved after percutaneous drainage.

CONCLUSIONS: A right hepatectomy preserving the MHV or its branches by minimally invasive techniques including total laparoscopic surgery was technically feasible. However, further refinements of the procedure are required prior to wide clinical application.

Author List

Suh KS, Yi NJ, Kim T, Kim J, Shin WY, Lee HW, Han HS, Lee KU

Author

Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Female
Hepatectomy
Hepatic Veins
Humans
Laparoscopy
Liver Transplantation
Living Donors
Male
Tissue and Organ Harvesting
Treatment Outcome
Young Adult