Pure laparoscopic living donor right hepatectomy (with video)
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ABSTRACT:
SUBMITTER: Gamez B
PROVIDER: S-EPMC8557347 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.
| S-EPMC7093441 | biostudies-literature
Project description:Laparoscopic living donor hepatectomy for transplantation has been well established over the past decade. This study aimed to assess its safety and feasibility in pediatric living donor liver transplantation (LDLT) by comparing the surgical and long-term survival outcomes on both the donor and recipient sides between open and laparoscopic groups. The medical records of 100 patients (≤17 years old) who underwent ABO-compatible LDLT using a left lateral liver graft between May 2008 and June 2016 were analyzed. A total of 31 donors who underwent pure laparoscopic hepatectomy and their corresponding recipients were included in the study; 69 patients who underwent open living donor hepatectomy during the same period were included as a comparison group. To overcome bias from the different distributions of covariables among the patients in the 2 study groups, a 1:1 propensity score matching analysis was performed. The mean follow-up periods were 92.9 and 92.7 months in the open and laparoscopic groups, respectively. The mean postoperative hospital stay of the donors was significantly shorter in the laparoscopic group (8.1 days) than in the open group (10.6 days; P < 0.001). Overall, the surgical complications in the donors and overall survival rate of recipients did not differ between the groups. Our data suggest that the laparoscopic environment was not associated with long-term graft survival during pediatric LDLT. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation.
| S-EPMC8246762 | biostudies-literature
Project description:BackgroundPure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas.MethodsThe medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011.ResultsSeventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure.ConclusionsPure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors.
| S-EPMC3572367 | biostudies-literature
Project description:INTRODUCTION:Total laparoscopic living donor right hepatectomy (TLDRH) is sporadically reported worldwide. Liver transection margin used to be determined by ischemic demarcation or intraoperative ultrasonography. To identify the site of bile duct division relied on preoperative MRCP and intraoperative cholangiography, which is experience demanding. PRESENTATION OF CASE:A 34-year-old man volunteered for living donation to his brother who suffered decompensated HBV-related cirrhosis. Right lobe donation without MHV fulfilled the volumetric criteria. After hilum dissection, ICG was injected into the right portal branch. Right lobe was transected tracing the real-time fluorescence-enhanced borderline and the course of MHV. The right bile duct was transected above the bifurcation that was fluorescently visualized within the parenchyma. The liver graft was retrieved from a pre-made suprapubic incision after simple vascular clamping. The warm ischemia time was 6?min. The recipient procedure was successful with back-table graft venoplasty using cryopreserved iliac artery allografts. The donor recovered uneventfully and was discharged from hospital on POD 7. DISCUSSION:The operative time, blood loss and postoperative course of donor is comparable to those undergoing ordinary laparoscopic right hepatectomy in our institute. ICG fluorescence can real-timely visualize the surgical margin and biliary branches of right lobe, which helps preserve every last bit of functional liver volume for the donor and avoid the complicated traditional intraoperative cholangiography. CONCLUSION:TLDRH proves to be achievable in surgical teams confortable with both laparoscopic hepatectomy and LDLT. ICG fluorescence navigation could make the procedure simplified, safer and more accurate. More practice and technical modification are necessary.
| S-EPMC6260439 | biostudies-literature
Project description:BACKGROUND:We present a living donor case with an unexpected large-volume pneumothorax diagnosed using lung ultrasound during a laparoscopic hepatectomy for liver transplantation (LT). CASE PRESENTATION:A 38-year-old healthy female living donor underwent elective laparoscopic right hepatectomy. The preoperative chest radiography (CXR) and computed tomography images were normal. The surgery was uneventfully performed with tolerable CO2 insufflation and the head-up position. SpO2 decreased and airway peak pressure increased abruptly after beginning the surgery. There were no improvements in the SpO2 or airway pressure despite adjusting the endotracheal tube. Eventually, lung ultrasound was performed to rule out a pneumothorax, and we verified the stratosphere sign as a marker for the pneumothorax. The surgeon was asked to temporarily hold the surgery and cease with the pneumoperitoneum. Portable CXR verified a large right pneumothorax with a small degree of left lung collapse; thus, a chest tube was inserted on the right side. The hemodynamic parameters fully recovered and were stable, and the surgery continued laparoscopically. The surgeon explored the diaphragm and surrounding structures to detect any defects or injuries, but there were no abnormal findings. The postoperative course was uneventful, and a follow-up CXR revealed complete resolution of the two-sided pneumothorax. CONCLUSION:This living donor case suggests that a pneumothorax can occur during laparoscopic hepatectomy due to the escape of intraperitoneal CO2 gas into the pleural cavity. Because missing the chance to identify a pneumothorax early significantly decreases the safety for living donors, point-of-care lung ultrasound may help attending physicians reach the final diagnosis of an intraoperative pneumothorax more rapidly and to plan the treatment more effectively.
| S-EPMC7495872 | biostudies-literature
Project description:Laparoscopic hepatectomy has rapidly evolved recently; however, laparoscopic anatomical hepatectomy has yet to become widely used, although anatomical hepatectomy is ideal, especially for curative treatment of hepatocellular carcinoma, and is widely accepted via open approach. This is because good-experienced skills, for example, exposing Glissonean pedicles and hepatic veins on the cutting plane, are required in order to perform anatomical hepatectomy via a pure laparoscopic approach. We obtained good results for various totally laparoscopic anatomical hepatectomies using the standardized techniques. We exposed the major hepatic veins from the root side by utilizing the unique view from the caudal side in the laparoscopic approach, and moved CUSA from the root side toward the peripheral side to avoid splitting the bifurcation of the hepatic vein. We performed totally laparoscopic anatomical hepatectomy for 47 patients from August, 2008, to December, 2012 (Table 1). In most types of anatomical hepatectomy, the mean blood loss was <500 ml. Conversion to open surgery was required in two patients. Postoperative complications were prolonged ascites in two, peroneal palsy in two, and biloma in one. Mortality was zero. The embedded video demonstrates totally laparoscopic right anterior sectorectomy. In conclusion, our standardized techniques make laparoscopic anatomical hepatectomy more feasible.
| S-EPMC4057640 | biostudies-literature
Project description:Right hepatectomy for hepatocellular carcinoma is the most common major operation in liver surgery; therefore, liver surgeons should know the fundamental surgical concept and techniques of the Glissonean pedicle approach. A J-shaped or reversed T laparotomy is performed in the right subcostal area. The Glissonean pedicle approach is performed at the hepatic hilus. In this approach, the right anterior and posterior Glissonean pedicles are encircled and ligated without liver dissection. The right hepatic artery, right portal vein and right hepatic duct in the hepatoduodenal ligament should be divided if the Glissonean pedicles cannot be approached easily. After confirming the border between the right and left liver, the liver parenchyma is dissected from the anterior surface of the liver to the anterior surface of the inferior vena cava (IVC). The V5 and V8 middle hepatic veins are divided and liver dissection is performed along the main middle hepatic vein. Finally, the anterior surface of the IVC and the trunk of the right hepatic vein are identified in the liver. This approach is widely known as the anterior approach described by Lai and Fan (World J Surg 20:314-8, 1996). However, this procedure had already been reported by Takasaki et al. (Shoukakigeka 7:1545-51, 1984) but since they did not report this procedure in English, their pioneering work on the anterior approach has not been recognized. The liver hanging maneuver described by Belghiti et al. (J Am Coll Surg 193:109-111, 2001) is also useful in right hepatectomy. Among the techniques used in right hepatectomy, the Glissonean pedicle approach, the anterior approach and the liver hanging maneuver are considered to be the most important.
| S-EPMC3233663 | biostudies-literature
Project description:Background and Aims:The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. The aim of this study was to evaluate the post-hepatectomy effect of using N-Acetylcysteine (NAC) infusion in living donors undergoing donor hepatectomy. Methods:In a prospective randomised non-blinded study, 50 healthy donors were enrolled; following hepatectomy patients were randomised into 2 groups: Group NC receiving NAC 150 mg/kg diluted in 100 ml glucose 5% over 40 minutes, followed by NAC 12.5 mg/kg in 500 ml glucose 5% over 4 hours. This was followed by NAC 6.25 mg/kg for 2 post-operative days, Group C (Control group) received ringer acetate infusion at same rate for 2 days. The primary outcome was serum lactate levels. Secondary outcomes were liver function tests, serum creatinine and urine output on intensive care unit (ICU) admission (0 hr.), after 24 hours and 48 hours, length of ICU stay. Results:Our study revealed significant reduction in serum lactate in Group NC at 0, 24 and 48 hours compared to C group (P = 0.017, 0.002, 0.014). INR values showed significant reduction after 48 hours in Group NC compared to Group C (P = 0.049). Total Bilirubin, ALT, and Creatinine, urine output and ICU stay showed no statistical difference between the 2 groups. Conclusion:The NAC protocol is a safe, cost-effective tool for improvement of post hepatectomy liver function and early stabilisation of the metabolic profile.
| S-EPMC7179774 | biostudies-literature
Project description:ObjectiveThe liver hanging maneuver (LHM) is rarely applied in laparoscopic right hepatectomy (LRH) because of the difficulty encountered in retrohepatic tunnel (RT) dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study's aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH.MethodsBetween March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed.ResultsThe median age of patients was 58 (range, 51-65) years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 (40-150) mm. The median operative time was 320 (282-358) min with a median blood loss of 200 (200-600) ml. Laparoscopic LHM was achieved in a median of 31 (21-62) min, and the median postoperative hospital stay was 14 (9-16) d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed.ConclusionsThe Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.
| S-EPMC5018618 | biostudies-literature
Project description:Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6-90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195-258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140-255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2. Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
| S-EPMC7844329 | biostudies-literature