Laparoscopic living donor hepatectomy for Pediatric Liver Transplantation

Abstract

papillary mucinous neoplasm (IPMN) involving the entire pancreas. Methods: The patient is a 61-year-old female with a history of stage I endometrial cancer post robotic assisted total hysterectomy and salpingo-oophorectomy who was diagnosed with multifocal IPMN. Endoscopic ultrasound with fine needle aspiration of a complex cyst at the pancreas neck was significant for a CEA of 2080. She is a type 1 diabetic on an insulin pump. Results: A total of 6 robotic ports were placed and the da Vinci Xi robotic system was used with the patient supine. The approach entailed: (i) Diagnostic laparoscopy (ii) Entry into the lessec sac (iii) Division of the short gastric vessels (iv) Exposure and dissection of the inferior pancreas border (v) Dissection and transection of the splenic artery (vi) Mobilization of the spleen (vii) Exposure of the splenic vein-superior mesenteric vein confluence and transection of the splenic vein (viii) Kocher maneuver (ix) Release of the Treitz and transection of proximal jejunum (x) Transection of the distal stomach (xi) Portal lymphadenectomy (xii) Dissection and transection of the gastroduodenal artery (xiii) Hepaticojejunostomy (xiv) Cholecystectomy (xv) Gastrojejunostomy. Conclusion: Robotic total pancreatectomy with splenectomy offers a minimally invasive approach to a major abdominal operation and is feasible in a stepwise, reproducible technique. Objective: The objectives of the video are to describe a minimally invasive technique for pancreatic necrosectomy and determine when pancreatic debridement is necessary over pseudocyst drainage. Methods: Three radially dilating ports were placed through the anterior abdominal wall and through the anterior gastric wall after endoscopic insufflation. A surgical cystgastrostomy was created after removing the previously placed clogged endoscopic stent. Pancreatic debridement was performed through this transgastric approach until the cavity was completely cleared of debris. The gastrotomy sites were closed at the end of the procedure. Results: The patient presented to our institution with severe sepsis three months after initial presentation of necrotizing pancreatitis. He was found to have a clogged stent and infected pancreatic necrosis. He underwent a laparoscopic transgastric necrosectomy for drainage of pus and complete pancreatic debridement. He recovered well and was discharged on postoperative day 4. Conclusion: Laparoscopic transgastric necrosectomy allows for complete debridement with a single definitive operation. MRI is useful in the assessment of solid debris versus fluid in peripancreatic necrotic collections. This approach is an effective strategy for walled-off retrogastric pancreatic necrosis and offers significant benefits in the recovery of these patients to pre-pancreatitis health.V16 Objective: One of the main criticism of laparoscopic liver resection, is that it is difficult, or not possible, to perform liver-sparing resections. The aim of this video is to present short videos where the intrahepatic Glissonian approach was used ...