Laparoscopic-Assisted Right Lobe Donor Hepatectomy

Koffron, Alan J.; Kung, Robert; Baker, Talia; Fryer, Jonathan P.; Clark, Lori; Abécassis, Michaël

doi:10.1111/j.1600-6143.2006.01498.x

Cited by 186 publications

(155 citation statements)

References 28 publications

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“…Several laparoscopy-assisted approaches have been reported; these have yielded good results, but the procedures have tended to be complex and expensive. [1][2][3][4] Furthermore, they have been undertaken only in a small number of patients. We introduced an upper midline incision (UMI) without any laparoscopic assistance for living donor right hepatectomy.…”

mentioning

confidence: 99%

Use of an upper midline incision for living donor partial hepatectomy: A series of 143 consecutive cases

et al. 2011

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Over a period of 2 years, we used an upper midline incision (UMI) without laparoscopic assistance in 143 consecutive living donor partial hepatectomy (LDPH) procedures, regardless of the graft type or the donor age, sex, body mass index, or body shape. Here we report surgical recommendations based on our experience with the use of UMIs in this context. The celiac axis (CA) depth ratio (the depth-to-width ratio for the trunk at the CA) was measured to define the shape of the abdominal cavity. A questionnaire was used to assess satisfaction and cosmetic outcomes in this population of donors. One hundred forty-one of the grafts (98.6%) were right grafts or extended right grafts; there were no donor deaths. The mean time of the operation up to graft retrieval in 141 right side grafts was 3 hours 1 minute. All donors recovered fully and returned to their previous activities. Major complications occurred in 9 patients (6.4%) and included reoperation due to bleeding (4), the insertion of a percutaneous drain (4), and rhabdomyolysis (1). Male sex, a large graft (>900 kg), a fatty liver (large fatty changes 10%), and a deep truncal cavity (a CA depth ratio > 0.35) were significant risk factors for a long graft retrieval time. The use of a wound protector significantly reduced wound complications. The cosmetic outcomes were more satisfactory when a UMI preceded partial hepatectomy instead of a conventional J-shaped incision (P ¼ 0.01).In conclusion, a UMI without laparoscopic assistance can be safely used for LDPH, regardless of the graft type or the donor characteristics. However, the procedure after a UMI is more difficult in male donors with large fatty livers and deep truncal cavities. Accordingly, these features can be used as exclusion criteria for surgeons not accustomed to this modified procedure. Liver Transpl 17:969-975, 2011. V C 2011 AASLD.Received November 8, 2010; accepted March 31, 2011.A major concern for individuals who volunteer to be living donors of liver tissue is the length of the incision that will be made. There have been several attempts to reduce the length of these incisions. Several laparoscopy-assisted approaches have been reported; these have yielded good results, but the procedures have tended to be complex and expensive.

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confidence: 99%

Use of an upper midline incision for living donor partial hepatectomy: A series of 143 consecutive cases

et al. 2011

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“…Alguns serviços têm realizado hepatectomia direita de rotina com bons resultados 33 . Mais recentemente, tem-se aplicado o método também nas ressecções para a retirada de enxertos parciais de doadores vivos de fígado 25,37 .…”

Section: Doenças Benignasunclassified

“…Nesse sentido, existe número crescente de séries na literatura atestando a exequibilidade e benefícios da ressecção VL para tumores hepáticos benignos com resultados bastante favoráveis 12,25,30,38 .…”

Section: Doenças Benignasunclassified

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Ressecões hepáticas por videolaparoscopia

Herman¹,

Coelho²,

Lupinacci³

et al. 2009

ABCD, arq. bras. cir. dig.

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INTRODUÇÃOOs avanços técnicos da cirurgia videolaparoscópica (VL) transformaram a terapêutica cirúrgica de grande número de doenças. Com a constante evolução e advento de novas tecnologias a VL tem sido empregada com bons resultados na ressecção de diversos órgãos intra-abdominais e retroperitoneais, tais como estômago, cólon, rins, pâncreas, adrenal e baço 12 . No tratamento de algumas doenças, como colecistolitíase e doença do refluxo gastroesofágico, transformaram-se na terapêutica de escolha com vantagens inquestionáveis sobre a abordagem convencional 41 .Na cirurgia hepática, o emprego da via VL está bem estabelecido em alguns procedimentos como biópsias hepáticas, destelhamento de cistos hepáticos simples e drenagem de abscessos 17 . No entanto, as ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia VL 7,12,13 .Os fatores para essa dificuldade passam pelo risco teórico de embolia gasosa, potencial de sangramento intraoperatório incontrolável, incertezas sobre a obtenção de margens cirúrgicas adequadas e risco de disseminação tumoral nos casos de doenças malignas, além da necessidade de grande incorporação de tecnologia, como a necessária para secção do parênquima hepático (bisturi harmônico, grampeadores vasculares laparoscópicos, etc), transdutores laparoscópicos para ultrassonografia intra-operatória e necessidade de afastadores e instrumentais específicos para a mobilização hepática. Adicionalmente a curva de aprendizado do método é longa, exigindo cirurgiões com experiência em cirurgia hepática e formação em cirurgia VL avançada 7,13,23 . A primeira hepatectomia VL foi publicada por Gagner at al. 16 em 1992 para o tratamento de hiperplasia nodular focal hepática e, em 1995, Ferzl et al. 14 reportaram a ressecção de um adenoma hepático de 9 cm no segmento IV. A primeira hepatectomia regrada foi publicada por Azagra et al 1 . em 1996, que realizaram uma segmentectomia lateral esquerda em paciente com adenoma hepático. Ulteriormente a essas experiências iniciais, trabalhos subsequentes restringiam-se a relatos e séries de casos de poucos centros especializados. Só mais recentemente, em especial nos últimos cinco anos, é que os trabalhos sobre o tema cresceram de forma expressiva 1,7,24,38 . (4):226-32 RESUMO -Introdução -As ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia videolaparoscópica. Apesar da complexidade do procedimento, da demanda de grande incorporação de tecnologia e necessidade de experiência em cirurgia hepática e laparoscópica, a indicação do método tem crescido de forma expressiva nos últimos anos. Objetivo -Realizar análise crítica do método, baseada nos trabalhos existentes na literatura, ressaltando o estado atual de suas indicações, exequibilidade, segurança, resultados e aspectos técnicos primordiais. Mé-todo -Foram identificados e analisados os trabalhos pertinentes nas bases de dados LILACS e PUBMED até dezembro de 2009, utilizando-se os descritores "liver resection", "laparoscopic" e "liver surgery". Não foram enc...

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“…[3][4][5] Because donor safety is the highest priority in living donor liver transplantation, once the safety of these new procedures has been proven, evaluating surgical scarrelated symptoms or complications following the use of different types of incisions should be considered. 5 We have conducted a cross-sectional study using a self-assessment questionnaire to survey the actual status of surgical scar-related complications (n 5 87).…”

Section: To the Editormentioning

confidence: 99%

Acute and chronic postsurgical pain after living liver donation: Incidence and predictors

Soyama¹,

Takatsuki²,

Hidaka³

et al. 2015

Liver Transpl

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TO THE EDITOR:We are very interested in the work of Holtzman et al. 1 The authors of that study addressed the fact that persistent postsurgical pain was reported by 31% of the donors at the 6-month follow-up and by 27% of the donors at the 12-month follow-up. In addition to the evaluation of pain, we would like to address the importance of also taking care of other surgical scar-related complaints. Jain et al. 2 reported the incidence of numbness of the abdominal skin between the subcostal incision and the umbilicus in recipients after liver transplantation. Surprisingly, 100% of the recipients included in the study by Jain et al. 2 (n 5 101) had persistent numbness even up to 9 years after surgery. Hence, abdominal wall numbness should be taken into account for living donors who have undergone a subcostal incision.Recently, there have been several attempts to reduce surgical scar-related complications by adopting different types of incisions other than a subcostal incision. [3][4][5] Because donor safety is the highest priority in living donor liver transplantation, once the safety of these new procedures has been proven, evaluating surgical scarrelated symptoms or complications following the use of different types of incisions should be considered. 5 We have conducted a cross-sectional study using a self-assessment questionnaire to survey the actual status of surgical scar-related complications (n 5 87). 6 Forty-two percent of the donors with a Mercedes-Benz (MB)-type incision with a median follow-up of 86 months (range, 35-168 months) complained of persistent pain; the longest follow-up period of a donor with persistent pain was 168 months. The rate of numbness was 30% in donors with the MB incision and was 29% in donors with subcostal incisions with a median follow-up of 21 months (range, 7-46 months), in contrast to a 10% occurrence of numbness in donors with an upper-midline incision, even though the follow-up period was relatively shorter in that group (median, 10.5 months; range, 13-26 months). Furthermore, a partial loss of cutaneous sensation was also observed in 47% of the MB incision group, 39% of the subcostal incision group, and 22% of the upper-midline incision group.We fully agree with Holtzman et al., 1 who concluded that understanding and improving pain outcomes has been identified as a key priority by liver transplant clinicians. 1 Liver transplant clinicians should meticulously follow up with living liver donors with respect to the surgical scar, paying attention not only to pain but also to several other types of possible complications, such as numbness, tactile abnormalities, and so on.

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Laparoscopic-Assisted Right Lobe Donor Hepatectomy

Cited by 186 publications

References 28 publications

Use of an upper midline incision for living donor partial hepatectomy: A series of 143 consecutive cases

Use of an upper midline incision for living donor partial hepatectomy: A series of 143 consecutive cases

Ressecões hepáticas por videolaparoscopia

Acute and chronic postsurgical pain after living liver donation: Incidence and predictors

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