腔镜辅助带肝中静脉活体右半肝供肝切取技术:附七例报道

目的 探讨腹腔镜辅助肝切除(assisted laparoscopic hepatectomy,ALH)技术在活体肝移植供体切取中的应用及其意义.方法 对201l年5月30日至9月1日我院7例成功施行腹腔镜辅助带肝中静脉(middle hepatic vein,MHV)活体右半肝供肝切取术的患者资料进行回顾分析.结果 供者残肝比例32.10％～38.31％.7例供者术后伤口疼痛较轻,未出现外科并发症.7例均为皮内缝合,术后7d伤口拆线,愈合良好.术后2周肝功能基本恢复正常.结论 ALH可安全用于带MHV的活体右半肝供肝切取.ALH兼顾腹腔镜手术微创和开腹手术安全性高的特点,更容易为供、受者接受.     

腹腔镜活体肝移植供肝切取技术要点及评价(附12例报告)

目的探讨腹腔镜活体肝移植供肝切取手术的技术要点和应用前景。方法回顾性分析2015年9月至2016年10月四川大学华西医院肝脏肝移植外科12例腹腔镜下活体肝移植供肝切取术病人资料。分析12例供者及相应12例受者的手术及预后情况。结果 12例供者中,切取不包括肝中静脉的右半肝6例,左外叶3例,不包括肝中静脉的左半肝3例。术中失血量400(100~600 mL)。供者住院时间7(4~10 d)。所有供者术后均无并发症发生及围手术期死亡。12例受者术前移植物受体体重比(GRWR)为0.94%(0.54%~3.70%)。手术时间625(405~720 min)。术中失血量750(200~3000)mL。术后住院时间20(7~40)d。1例受者病人术后第7天发生消化道出血,保守治疗后出血停止。1例受者病人术后出现肺部感染,保守治疗后无效于术后第8天因呼吸衰竭死亡。其余受者病人术后顺利出院。结论随着技术的不断发展和器械的不断改进,腹腔镜活体肝移植供肝切取将有广阔的应用前景。     

精准肝脏外科理念在儿童活体肝移植供肝切取术中的临床价值

目的 探讨精准肝脏外科理念在儿童活体肝移植供肝切取术中的临床价值.方法 回顾性分析2012年12月至2014年1月上海交通大学医学院附属仁济医院收治的58例儿童活体肝移植供者的临床资料.术前对供者行CT等检查,将二维影像学数据进行三维重建,评估供者肝内胆管和血管情况,并对肝左动脉和肝左静脉解剖结构进行分型,测算供者标准肝脏体积、拟切取肝脏体积和受者标准肝脏体积,模拟手术操作,制订手术方案.采取精准肝切除切取供肝.采用门诊和电话方式进行随访,随访时间截至2014年4月.结果 58例儿童活体肝移植供者术前CT血管造影检查示肝左动脉Ⅰ型28例、Ⅱ型10例、Ⅲ型20例、无Ⅳ型供者;肝左静脉Ⅰ型35例、Ⅱ型23例.三维重建预测拟切取肝脏体积为(243±65) mL.58例供者均成功完成供肝切取术,其中7例为左半肝切取,51例为肝左外叶切取.2例供者行胆囊切除.术中实际切取肝脏体积为(255±59) mL,拟切取肝脏体积平均误差率为4.94％.移植物质量与受者体质量比为3.3％±1.0％.手术时间为(260±89)min,术中出血量为(181±35)mL,仅1例供者术中输RBC 2 U.供者术后胃肠功能恢复时间为(2.0±1.1)d,术后拔除引流管时间为(3.0±1.2)d,术后住院时间为(7±3)d,出院时所有供者血清WBC、Hb、ALT、AST、TBil、DBil、AIb等指标水平正常.2例供者术后发生并发症,分别为切口少量渗血和脂肪液化,均经对症治疗后痊愈.58例儿童活体肝移植供者术后均获得随访,中位随访时间为8.7个月.供者恢复良好,随访期间无并发症发生.结论 精准肝脏外科理念应用于儿童活体肝移植供肝切取术,切取准确率高、供者肝功能损害小、术后并发症少、恢复快.     

活体肝移植不同供肝切取方式对残肝再生的影响

目的 探讨活体肝移植不同方式供肝切取术后供者康复及肝脏再生情况.方法 回顾性分析2006年5月至2011年5月13例活体肝移植供者临床资料.对不同方式供肝切取手术方法、供者术后肝功能指标变化及残肝再生情况进行比较.结果 供者手术分为不包含肝中静脉右半肝切除8例,包含肝中静脉右半肝切除2例,左半肝切除3例.供者肝功能及凝血指标均于术后两周恢复正常,术后未见严重并发症,随访情况良好,无供者死亡.术前CT估算供肝体积与术中实际切取供肝重量呈正相关(r＝0.838,P＜0.01).术后复查CT测残肝体积示:右半肝供者残肝较左半肝供者残肝再生速度快,不带肝中静脉右半肝供者较带肝中静脉右半肝供者残肝再生速度略高,但供者肝脏功能恢复无明显差异.结论 不同术式活体肝移植供者在规范化围手术期处理、精细手术操作后肝功能均能得到较好的康复,而供肝切取术后残肝再生速度则受切取比例、残肝供血情况、细胞因子调控等多因素影响.     

机器人辅助腹腔镜在活体供肝左外叶切取术中的应用

目的探讨机器人辅助腹腔镜下活体供肝切取术的可行性和安全性。方法回顾性分析2021年6月至2022年9月天津市第一中心医院器官移植中心行活体左外叶供肝切取45例供者及受者的临床资料。其中, 15例行机器人辅助腹腔镜下活体供肝切取(机器人辅助手术组), 30例行传统开腹供肝切取(传统开腹手术组)。对比分析两组手术时间、术中出血、术后恢复、术后并发症等情况。采用SPSS 21.0进行统计学分析, 进行独立样本T检验、配对样本T检验、Wilcoxon秩和检验和卡方检验来分析两组之间的差异。结果传统开腹手术组的手术时间、术中出血量和术后住院时间分别为(236.0±58.7)min、(251.0±144.8)ml和7.0(6.0, 9.0)d, 与机器人辅助手术组(337.5±66.7)min、(106.0±39.8)ml和6.0(6.0, 6.0)d比较, 差异均有统计学意义(P<0.001、P=0.001和P<0.05)。传统开腹手术组供者术后出现胆漏2例;腹腔感染2例, 其中1例为肝断面胆漏引起, 最终行二次剖腹手术;切口感染1例;肝中静脉及其部分分支血栓形成1例。机器人辅助手术...     

活体肝移植的供肝切取手术40例临床分析

目的：探讨活体肝移植的供肝切取技术,方法：在1993年9月至1999年6月期间,香港大学玛丽医院共作活体肝移植40例,供肝切取包括：左外侧叶14例,左半有6例,右半肝20例,术中首先行肝门解剖,肝叶游离,然后用超声刀切取供肝、术中不阻断肝血流。切取肝左外侧叶和左半肝时切面分别靠近镰状韧带的右侧和中肝静脉的右侧,切取右半肝的切面靠近中肝静脉的左则。结果：切取供体手术时间为7．2-15.5h平均11．0h,供体手术的平均失血量为723ml(200ml-2600ml）。7例供体发生了术后并发症,包括切口感染,切口疝,右肺上叶不张,右膈下积液,粘连性肠梗阻,术后高胆红素血症及胆管狭窄各1例,经治疗后均痊愈。目前所有的从体肝功能均正常,完全恢复体力,恢复原来的工作,结论：极度仔细及精良的供肝切取技术是安全的,在尸肝缺乏时活体肝脏切取技术可为肝移植提供优质的供肝。     

活体肝移植的供肝处理技巧

目的 探讨活体肝移植术供肝的选择，切取和修整，方法 1997至2001年期间，第四军医大学西京医院共完成活体肝移植术3例。其中2例是儿童活体肝移植术，另1例是成人辅助性原位活体肝移植术，供肝切取均为左外叶，供者术中作必要的肝周韧带游离和肝门解剖，超声刀切取供肝，不阻断肝脏血流。结果 供者手术时间为5-6.5h，失血量为200-400ml，无并发症发生。目前所有的供者肝功能均正常。恢复正常的工作和生活。结论 左肝外叶切除对供者是非常安全的。一般无手术并发症发生。     

成人间活体肝移植94例报告

目的 探讨成人间活体肝移植供者评估、手术方式的选择及术后并发症分析.方法 收集2007年1月至2010年8月同一外科组施行的94例成人间活体肝移植的临床资料.受者年龄18 ～76岁,供者年龄19 ～60岁.94例活体肝移植手术方案包括:左半肝供肝移植2例,右半肝供肝移植92例,44例切取肝中静脉例,48例不切取肝中静脉.分析供受者术前评估、术后并发症及存活情况.结果 所有供者均恢复良好出院,供者并发症发生率为7.4％.随访截止于2011年5月31日,中位随访时间为37个月,死亡8例.供者1年存活率为95.7％,移植物存活率为94.7％.1例发生小肝综合征;1例因急性肝坏死行再次肝移植;24例(25.5％)经胆道造影或磁共振胰胆管成像检查发现胆道吻合口狭窄,但其中9例(9.6％)表现为肝功能异常.结论 活体肝移植是治疗终末期肝病的有效方法,精确的术前评估、合理手术方式选择,采用左半肝或右半肝供肝、含或不含肝中静脉的活体肝移植,在成人间活体肝移植中均能有效的保证供受者安全.     

机器人辅助腹腔镜与后腹腔镜活体供肾切取术的临床研究

目的比较机器人辅助腹腔镜活体供肾切取术与后腹腔镜活体供肾切取术的临床疗效,评估机器人辅助腹腔镜供肾切取术对供、受者的安全性和有效性。方法回顾性分析2013年9月至2015年8月第四军医大学西京医院泌尿外科31例行机器人辅助腹腔镜活体供肾切取术(机器人组)及29例行后腹腔镜活体供肾切取术(后腹腔镜组)供、受者临床资料。比较机器人组和后腹腔镜组供者术前一般情况、手术时间、热缺血时间、术中出血量、住院时间、并发症发生情况、术后随访情况,以及两组受者手术前后血清肌酐值、手术并发症和术后移植肾功能。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果机器人组与后腹腔镜组手术均顺利完成。两组供者术中出血量分别为(39±15)和(62±37)m L,住院时间分别为(4.6±1.0)和(5.4±1.5)d,差异均有统计学意义(t=3.01和2.46,P均0.05);手术时间、热缺血时间及并发症发生率差异均无统计学意义(P均0.05)。此外,机器人辅助腹腔镜组2例供者术中出现脾脏损伤,1例出现术后出血;后腹腔镜组1例供者术后出现泌尿系统感染,1例术后术后第6天发现髂外静脉血栓,1例术后出现伤口脂肪液化。两组供者术后随访6个月以上,均无高血压、蛋白尿、肾功能异常等并发症发生。两组受者术后第7、30天血清肌酐值分别为(120±26)和(132±43)μmol/L,(115±18)和(118±39)μmol/L,差异均无统计学意义(t=0.78和0.96,P均0.05)。机器人组及后腹腔镜组受者移植肾存活比例分别为100.0%(31/31)和96.6%(28/29)。结论机器人辅助腹腔镜活体供肾切取术具有安全、可靠、创伤小、恢复快、不影响供移植肾功能等优势,是一种可供选择的供肾切取方式。     

成人活体肝移植71例报道

目的 探讨开展成人活体肝移植初始阶段如何确保供、受者安全.方法 回顾性分析我院2007年4月至11月71例成人活体肝移植供、受者临床资料,分析评估方案、手术策略和并发症.结果 切取供者右半肝68例,其中带肝中静脉4例;切取带肝中静脉左半肝3例.术后出现并发症2例,1例胆漏,1例腹腔内出血,无供者死亡.受者外科并发症18例,其中胆道并发症12例,血管并发症3例,小肝综合征3例;病死率为10%(7/71).结论 在开展成人活体肝移植的初始阶段,采用严格的供、受者评估、选择合理的手术方式和术后处理可以最大程度地保证供、受者安全.     

Laparoscopy-Assisted Donor Right Hepatectomy Using a Hand Port System Preserving the Middle Hepatic Vein Branches

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. This article was presented at the 2008 Joint International Congress of ILTS, ELITA, LICAGE, Paris, France, July 9–12, 2008.     

Laparoscopic Hepatectomy for a Modified Right Graft in Adult-to-Adult Living Donor Liver Transplantation

Background

We performed a modified right hepatectomy completely by laparoscopic techniques preserving the middle hepatic vein (MHV) branches in adult-to-adult living donor liver transplantation (LDLT).

Patients and Methods

Two young women (24 and 25 years old) volunteered to be live donors for their parents who had hepatocellular carcinomas. As the donors expressed concerns about scarring, we performed a laparoscopic procedure using a hand port device. Mobilization of the right liver and the hepatic parenchymal transection were performed under pneumoperitoneum. Parenchymal transection was performed using a laparoscopic ultrasonic aspirator without the Pringle maneuver. During parenchymal transection, major MHV branches >5 mm were preserved using Hem-o-lock clips. The graft was extracted through the hand port site. On the back table, the 3 MHV branches were reconstructed using an artificial vascular graft. The livers were transplanted without complications.

Results

The operative times for the donors were 765 and 898 minutes. The donors did not require transfusions or reoperation; they were discharged on postoperative days 10 and 14 with normal liver functions.

Conclusion

A hepatectomy performed completely by laparoscopic techniques for a right graft with preservation of the MHV branches was technically feasible.     

Use of middle hepatic vein in right lobe living donor liver transplantation

The harvesting of the middle hepatic vein (MHV) with the right lobe graft for living‐donor liver transplantation allows an optimal venous drainage for the recipient; however, it is an extensive operation for the donor. This is a prospective, nonrandomized study evaluating liver functions and early clinical outcome in donors undergoing right hepatectomy with or without MHV harvesting. From August 2005 to July 2007, a total of 100 donor right hepatectomies were performed with (n = 49) or without (n = 51) the inclusion of the MHV. The decision to take MHV was based on an algorithm that considers various donor and recipient factors. There was no donor mortality in donors in either group. Overall complication rate was higher in MHV (+) donor group, however when remnant liver volume was kept above 30%, complication rates were similar between the groups. The results of this study show that right hepatectomy including the MHV neither affects morbidity nor impairs early liver function in donors when remnant volume is kept above 30%. The decision, therefore, of the extent of right lobe donor hepatectomy should be tailored to the particular conditions considering the graft quality and metabolic demand of the recipient.     

Effect of Middle Hepatic Vein Tributaries Preserving Technique Until Just Before Graft Retrieval on Donors' Surgical Outcomes in Living Donor Liver Transplantation

Background

The technique of preserving the major tributaries of the middle hepatic vein (MHV) (V5 and V8) until just before graft retrieval is beneficial to minimize congestion time of the graft. However, it remains unclear whether this technique exerts a burden on donors in terms of operative time, blood loss, and postoperative hepatic dysfunction. In this study we investigated adverse effects of the MHV tributaries preserving technique until immediately before graft retrieval on donors' surgical outcomes.

Laparoscopy-Assisted Hybrid Left-Side Donor Hepatectomy

Background

Laparoscopic liver resection developed for live liver donors has the advantage of reducing the physical and mental stress in donors. However, its safety and efficacy still remain to be established. We aimed to evaluate the feasibility, safety and efficacy of laparoscopy-assisted hybrid donor hepatectomy (LADH) to obtain left side grafts.

Patients and methods

A total of 31 consecutive live liver donors of left side liver grafts underwent LADH, including left lateral segmentectomy (n = 17) and left liver resection with or without the caudate lobe (n = 14) (LADH group). We compared the clinical data between the LADH group and the group of donors in whom traditional open donor hepatectomy was performed to procure the liver graft (open donor hepatectomy [ODH] group, n = 79).

Results

Laparoscopy-assisted hybrid donor hepatectomy was feasible in all patients, and there was no mortality over a follow-up period of 13.9 ± 9.8 months. The operative time to procure a left-lobe graft was significantly longer in the LADH group (510 ± 90 min) than in the ODH group (P < 0.001). A large right lobe on CT (RPv distance) was identified as a significant risk factor for prolonged operative time (P = 0.007). Evaluation using the SF36-v2 questionnaire revealed faster recovery of the physical component summary score and bodily pain score in the LADH group than in the ODH group.

Conclusions

Laparoscopy-assisted hybrid donor hepatectomy for procuring left side grafts was safe and effective up to the left liver with the caudate lobe. Left-lobe LADH in donors with a large right lobe should be carefully planned in view of the potential surgical difficulty.     

Sling suspension of the liver in donor operation: a gradual tape-repositioning technique

BACKGROUND: To control bleeding in the deeper parenchymal plane in right hepatectomy, Belghiti et al. (J Am Coll Surg 2001;193:109) proposed a liver-hanging maneuver using a sling passed between the anterior surface of the inferior vena cava (IVC) and the liver parenchyma. We applied this technique in donor operations in which a hepatic parenchymal transection should be performed before dividing the feeding or draining vessels for the graft. METHODS: After passing a tape between the liver and the IVC, the lower tip of the tape is pulled up behind the hepatic hilum to enable effective traction of the dorsal part of the liver. To preserve significant middle hepatic vein (MHV) tributaries in right-liver graft, the tape is gradually repositioned behind the veins, and parenchymal transection is completed before dividing the venous tributaries. Congestion of the graft is minimal until harvest. In right hepatectomy with the MHV, the tape is switched behind the MHV to preserve the MHV. RESULTS: Since March 2000, this technique has been used in 71 consecutive donor operations, including 37 right hepatectomies without the MHV, 8 right hepatectomies with the MHV, 20 left hepatectomies with the caudate lobe, and 6 right lateral sectorectomies. Taping behind the liver was successful in all but one donor (98.6%). There were no major complications related to this procedure. CONCLUSIONS: This new approach to the sling suspension of the liver with a gradual tape manipulation facilitated the suspending action and was useful in four types of donor operation. These techniques are feasible in most living donors and are recommended as basic procedures to enhance the safety of the donor and the quality of the graft.     

Comparison of Laparoscopy-Assisted and Open Donor Right Hepatectomy: a Prospective Case-Matched Study from China

Background

Laparoscopy-assisted hepatectomy is a new minimally invasive approach for graft harvesting in living donors. Only a few liver transplant centers have introduced this surgical procedure.

Methods

A prospective case-matched study was conducted on 25 consecutive donors who underwent laparoscopy-assisted donor right hepatectomy (LADRH) between July 2011 and March 2013 at our transplant center. These donors were matched 1:1 according to age, gender, and body mass index with 25 donors who underwent open donor right hepatectomy (ODRH).

Results

LADRH was successfully performed in all 25 of the donors. Donor complications, estimated blood loss, and operative time were similar between the groups. Hospital stay and periods of analgesic use were significantly shorter in the LADRH group [7.0?±?1.4 (LADRH) vs 8.7?±?2.4 (ODRH), p?=?0.003, and 2.4?±?1.0 (LADRH) vs 3.2?±?1.0 (ODRH), p?=?0.011, respectively). The total in-hospital cost is higher with LADRH, primarily due to the additional material costs for LADRH. Finally, there were no differences in graft size, graft survival, or recipient complications between the two groups.

Conclusion

The results of this study show that LADRH is a feasible and safe procedure compared with ODRH. Although higher material costs for laparoscopic assisted procedures are inevitable, LADRH may have an advantage over ODRH by causing less pain and facilitating earlier recovery. Efforts can be made to improve the technical success of LADRH for some overweight donors.     

Safety of donor right hepatectomy without abdominal drainage: a prospective evaluation in 100 consecutive liver donors.

Although the role of routine abdominal drainage after liver resection for tumors has been questioned, abdominal drainage after donor right hepatectomy for live donor liver transplantation (LDLT) has been a routine practice in most transplant centers. The present study aimed to evaluate the safety of the procedure without abdominal drainage. A prospective study was performed on 100 consecutive liver donors who underwent right hepatectomy for LDLT from July 2000 to September 2003. Biliary anatomy was carefully studied with intraoperative cholangiography using fluoroscopy. The middle hepatic vein was included in the graft in all except 1 patient. Parenchymal transection was performed using an ultrasonic dissector. The right hepatic duct was transected at the hilum and the stump was closed with 6-O polydioxanone continuous suture. Absence of bile leakage was confirmed with methylene blue solution instilled through the cystic duct stump. The abdomen was closed after careful hemostasis without drainage in all donors. The median age of the donors was 36 years (range 18-56 years). Median operative blood loss and operating time were 350 mL (range 42-1,400 mL) and 7.5 hours (range 5.2-10.7 hours), respectively. None of the donors required any blood or blood product transfusion. There was no operative mortality. The median postoperative hospital stay was 8 days (range 5-30 days). Postoperative morbidity occurred in 19 patients (19%), most of which were minor complications. No donor experienced bile leakage, intraabdominal bleeding, or collection. None required surgical, radiologic, or endoscopic intervention for postoperative complications, except for 1 donor who developed late biliary stricture that required endoscopic dilatation. All donors were well with a median follow-up of 32 months (range 11-50 months). In conclusion, with detailed study of the biliary anatomy and meticulous surgical technique, donor right hepatectomy can be safely performed without abdominal drainage. Abdominal drainage is not a mandatory procedure after donor hepatectomy in LDLT.     

Hepatic venous congestion in living donor liver transplantation: preoperative quantitative prediction and follow-up using computed tomography.

Hepatic venous congestion (HVC) has not been assessed quantitatively prior to hepatectomy and its resolving mechanism has not been fully analyzed. We devised and verified a new method to predict HVC, in which HVC was estimated from delineation of middle hepatic vein (MHV) tributaries in computed tomography (CT) images. The predicted HVC was transferred to the right hepatic lobes of 20 living donors using a paper scale, and it was compared with the actual observed HVC that occurred after parenchymal transection and arterial clamping. The evolution of HVC from its emergence to resolution was followed up with CT. Volume proportions of the predicted and observed HVC were 31.7 +/- 6.3% and 31.3 +/- 9.4% of right lobe volume (RLV) (P =.74), respectively, which resulted in a prediction error of 3.8 +/- 3.7% of RLV. We observed the changes in the HVC area of the right lobes both in donors without MHV trunk and in recipients with MHV reconstruction. After 7 days, the HVC of 33.5 +/- 7.7% of RLV was changed to a computed tomography attenuation abnormality (CTAA) of 28.4 +/- 5.3% of RLV in 12 donor remnant right lobes, and the HVC of 29.1 +/- 11.5% of RLV was reduced to a CTAA of 9.3 +/- 3.2% of RLV in 7 recipient right lobe grafts with MHV reconstruction. There was no parenchymal regeneration of the HVC area in donor remnant livers during first 7 days. In conclusion, we believe that this CT-based method for HVC prediction deserves to be applied as an inevitable part of preoperative donor evaluation. The changes in CTAA observed in the right lobes of donors and recipients indicate that MHV reconstruction can effectively decrease the HVC area.     

Single-port laparoscopy-assisted donor right hepatectomy in living donor liver transplantation: sensible approach or unnecessary hindrance?

Background

Single-port laparoscopic (SPL) surgery has rapidly gained attention worldwide. Since May 2008, we have propagated the use of SPL surgery, mainly for cholecystectomy and appendectomy. Recently, we have used this modality of minimally invasive surgery for various liver surgeries. We hereby discuss our outcomes of SPL-assisted donor right hepatectomies.

Methods

The preoperative workup is the same as for a standard donor hepatectomy. We retrospectively reviewed the data of 150 patients who underwent donor right hepatectomy from October 2008 to May 2011. We divided them into 3 groups depending on the type of surgical procedure.

Results

Among 150 patients, 20 underwent laparoscopy-assisted donor right hepatectomy (LADRH); 40 underwent single-port laparoscopy-assisted donor right hepatectomy (SPLADRH); and 90 underwent open donor right hepatectomy (ODRH). The donor demographics were comparable among the groups. Postoperative complication and reoperation rates revealed no significant differences. The SPLADRH group showed the lowest level of postoperative pain, thereby leading to a better quality of life postoperatively.

Conclusions

SPLADRH seems to be a simple, feasible approach.