Donor safety in live donor laparoscopic liver procurement: systematic review and meta-analysis

Bekheit, Mohamed; Khafagy, P.; Bucur, Petru; Katri, Khaled; El-Gendi, Ahmed; Abdel-Salam, Wael; Vibert, Éric; El-kayal, El Said

doi:10.1007/s00464-014-4045-1

Cited by 28 publications

(21 citation statements)

References 62 publications

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“…The three studies[13,20,22] that evaluated recipient survival rate found no significant between-group difference. Other reports[38] evaluated several of the studies included in our meta-analysis, reporting survival rate but not postoperative liver function.…”

Section: Discussionmentioning

confidence: 99%

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

Zhang

Chen

et al. 2017

WJG

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AIMTo perform a systematic review and meta-analysis on minimally vs conventional invasive techniques for harvesting grafts for living donor liver transplantation.METHODSPubMed, Web of Science, EMBASE, and the Cochrane Library were searched comprehensively for studies comparing MILDH with conventional living donor hepatectomy (CLDH). Intraoperative and postoperative outcomes (operative time, estimated blood loss, postoperative liver function, length of hospital stay, analgesia use, complications, and survival rate) were analyzed in donors and recipients. Articles were included if they: (1) compared the outcomes of MILDH and CLDH; and (2) reported at least some of the above outcomes.RESULTSOf 937 articles identified, 13, containing 1592 patients, met our inclusion criteria and were included in the meta-analysis. For donors, operative time [weighted mean difference (WMD) = 20.68, 95%CI: -6.25-47.60, P = 0.13] and blood loss (WMD = -32.61, 95%CI: -80.44-5.21, P = 0.18) were comparable in the two groups. In contrast, analgesia use (WMD = -7.79, 95%CI: -14.06-1.87, P = 0.01), postoperative complications [odds ratio (OR) = 0.62, 95%CI: 0.44-0.89, P = 0.009], and length of hospital stay (WMD): -1.25, 95%CI: -2.35-0.14, P = 0.03) significantly favored MILDH. No differences were observed in recipient outcomes, including postoperative complications (OR = 0.93, 95%CI: 0.66-1.31, P = 0.68) and survival rate (HR = 0.96, 95%CI: 0.27-3.47, P = 0.95). Funnel plot and statistical methods showed a low probability of publication bias.CONCLUSIONMILDH is safe, effective, and feasible for living donor liver resection with fewer donor postoperative complications, reduced length of hospital stay and analgesia requirement than CLDH.

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Section: Discussionmentioning

confidence: 99%

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

Zhang

Chen

et al. 2017

WJG

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“…EndoGIA staplers are widely used to manage vessels in laparoscopic nephrectomy because of their feasibility and safety and their use has become standard practice [19][20][21]. This is the reason why, we preferred EndoGIA from the beginning of our experience in patients underwent LDN [22].…”

Section: Discussionmentioning

confidence: 99%

Bleeding Control and Vascular Preservation in Laparoscopic Living Donor Nephrectomy. Powered vs. Mechanical Vascular Stapler: A Possible Real Advantage

Gl¹,

Baccarani²,

Cherchi³

et al. 2017

J Kidney

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Kidney transplantation (KTx) is the treatment of choice for end stage renal disease (ESRD), improving both quality, and quantity of life in the recipients. Living Donor Kidney Transplantation (LDKT) is both related to a longer patient and graft survival, and laparoscopic donor nephrectomy (LDN) is the procedure of choice by most transplants Centers. Even though many techniques have been used to secure both the renal artery and vein during laparoscopic nephrectomy (Hem-o-lock clips, titanium clips or Vascular Stapler), ligation and division of the renal hilum remain two critical steps, entailing a certain risk of serious complications. Mechanical EndoGIA vs. iDrive ™ Ultra Powered Stapling System (Autosuture; Covidien Surgical, Mansfield) have been compared. iDrive ™ is a reusable, handled stapler computer-controlled stapling systems that runs on battery and can be used on multiplepatients. It comprises a hand-held control unit, and a loading unit, which consists in a powered EndoGIA cartridge. We evaluated safety, efficacy, maneuverability and ergonomics for renal vascular control during LDN. Moreover, the differences in costs between the two procedures were also analyzed. There were no malfunctions or complications related to the use of iDrive ™ requiring conversion to open procedure. Advantages in maneuverability and costs were also observed. The total timing related to the use of the devices was statistically significant shorter for the iDrive ™ than for the EndoGIA being respectively 3.4 ± 0.4 minutes vs. 4.2 ± 0.4 minutes (p=0.0014). In our experience, iDrive ™ is safe and feasible for separate ligation and accurate division of renal artery and vein during LDN. The system also helps to minimize the need for additional maneuvers to secure the renal hilum. Furthermore, it allows greater precision of cutting on the kidney vessels that will have to be used for transplantation.

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“…Surgical procedures in PLS should be carefully considered and well established [1,3,9,11,15,16], and we should consider that PLS commonly requires a longer operative time than OS [10]. Some researchers have reported advantageous points of PLS for LDs, such as less blood loss, less pain, a shorter hospital stay, and earlier social reintegration [3,5,6,14]. We also understand that many LDLT surgeons wish to attempt PLS for LDs [1,5,7,9,11,14].…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative damage should be minimized as much as possible, and an LD for LDLT is the best target for minimally invasive surgery [1,5,7,9,11-14] because he or she inherently requires no invasive surgical procedures. Additionally, a donor safety rate of 100% should be guaranteed [6,7,15,16]. …”

Section: Introductionmentioning

confidence: 99%

Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

Hori

Kaido

Iida

et al. 2016

aog

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BackgroundA living donor (LD) for liver transplantation (LT) is the best target for minimally invasive surgery. Laparoscope-assisted surgery (LAS) for LDs has gradually evolved. A donor safety rate of 100% should be guaranteed.MethodsWe began performing LAS for LDs in June 2012. The aim of this report is to describe the surgical procedures of LAS in detail, discuss various tips and pitfalls, and address the potential for a smooth transition to more advanced LAS.ResultsPreoperative planning based on three-dimensional image analysis is a powerful tool for successful surgery. The combination of liver retraction/countertraction and the pressure produced by pneumoperitoneum widens the dissectible/cuttable layer, increasing the safety of LAS. A flexible laparoscope provides excellent magnified vision in both the horizontal view along the inferior vena cava, under adequate liver retraction, and in the lateral view, to harvest left-sided grafts in critical procedures. Intentional omission of painful incisions is beneficial for LDs. Hepatectomy using a smaller midline incision is safe if a hanging maneuver is used. Safe transition from LAS to a hybrid technique involving a combination of pure laparoscopic surgery and subsequent open surgery seems possible.ConclusionLDLT surgeons have a very broad intellectual and technical frontier.

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Donor safety in live donor laparoscopic liver procurement: systematic review and meta-analysis

Abstract: Live donor laparoscopic liver procurement could be as safe as the conventional open approach. Lower blood loss and lower consumtion of analgesics might be offered in the laparoscopic approach.

Cited by 28 publications

References 62 publications

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

Bleeding Control and Vascular Preservation in Laparoscopic Living Donor Nephrectomy. Powered vs. Mechanical Vascular Stapler: A Possible Real Advantage

Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

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