Microscope‐assisted hepatic artery reconstruction in adult living donor liver transplantation—A review of 325 consecutive cases in a single center

Lee, Chen‐Fang; Lu, Johnny Chuieng Yi; Zidan, Ahmed; Wu, Tsung‐Han; Chan, Kun‐Ming; Lee, Wei‐Chen

doi:10.1111/ctr.12879

Cited by 20 publications

(30 citation statements)

References 17 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are arguments favoring arterial reconstruction using either a microscope or a loupe but not showing a statistical significance with respect to HAT (6,(23)(24)(25)(26)(27); but there are no randomized trials. Our view is that loupes can give only a fixed working distance, fixed magnification, smaller field of view, limited Illumination, can cause weight burden on head and nose and can result in a spinal compression in a surgeon.…”

Section: Discussionmentioning

confidence: 99%

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Lin

Prasad

Chen

et al. 2019

Hepatobiliary Surg. Nutr

View full text Add to dashboard Cite

Background: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. Methods: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. Results: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate redo anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. Conclusions: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to redo the HAR immediately.

show abstract

Section: Discussionmentioning

confidence: 99%

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Lin

Prasad

Chen

et al. 2019

Hepatobiliary Surg. Nutr

View full text Add to dashboard Cite

show abstract

“…All three studies' patient populations were vastly different from ours when comparing patient demographics and etiologies of liver failure. 11,12 To our knowledge, this is the first study which analyzes LDLTs completed with collaboration between transplant surgeons and microsurgeons in a North American, combined, adult, and pediatric population. One surgeon in this study utilized a loupe-based approach (n ¼ 23 patients in study), while the other employed the surgical microscope (n ¼ 15 patients in study) .…”

Section: Discussionmentioning

confidence: 99%

“…While studies have analyzed the differences between the use of loupes and the microscope in this procedure, this topic is still under debate. 11,13,14 Some highlight the importance of operating microscope use for not just HA anastomosis, but also surveillance of HAT risk factors. They argue the microscope allows surveillance of dissociation between intimal and medial vessel layers while also providing an opportunity to observe potential soft thrombus formation within the arterial stumps.…”

Section: Discussionmentioning

confidence: 99%

“…They argue the microscope allows surveillance of dissociation between intimal and medial vessel layers while also providing an opportunity to observe potential soft thrombus formation within the arterial stumps. 11 However, multiple studies have directly compared HA reconstruction with loupes versus operating microscope and found no difference in HA-related complications. 11,14 The reconstructive microsurgeons involved in the HA anastomosis in our study performed anastomoses in an interrupted fashion.…”

Section: Discussionmentioning

confidence: 99%

“…11 However, multiple studies have directly compared HA reconstruction with loupes versus operating microscope and found no difference in HA-related complications. 11,14 The reconstructive microsurgeons involved in the HA anastomosis in our study performed anastomoses in an interrupted fashion. Another debated topic in this field is continuous versus interrupted suture technique, with proponents of the continuous technique arguing for its ease/speed and proponents of the interrupted technique arguing for reduced HA complications 13,[15][16][17] , although no consensus has been reached.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Analysis of Outcomes in Living Donor Liver Transplants Involving Reconstructive Microsurgeons

Hernández

Mullens

Aoyama

et al. 2019

J reconstr Microsurg

View full text Add to dashboard Cite

Background Living donor transplantation is becoming increasingly popular as a modality for patients necessitating liver transplantation. Hepatic artery thrombosis (HAT) remains the most feared acute postoperative complication associated with living-donor liver transplantation. Preoperative planning, including scheduling reconstructive microsurgeons to perform the hepatic artery anastomosis using a surgical microscope or loupes, can decrease HAT rates. Methods A retrospective review of two reconstructive microsurgeons at a single institution was performed to analyze postoperative outcomes of adult and pediatric live donor liver transplants where reconstructive microsurgeons performed the hepatic artery anastomosis. One surgeon utilized the surgical microscope, while the other surgeon opted to use surgical loupes for the anastomosis. Results A total of 38 patients (30 adult and eight pediatric) met inclusion criteria for this study, and average patient age in the adult and pediatric population studied was 48.5 and 3.6 years, respectively. Etiologies of adult patients' liver failure were most commonly cholestatic (43%), followed by alcohol (23%), hepatitis C virus-related cirrhosis (17%), and nonalcoholic steatohepatitis (7%), while etiologies of pediatric liver failure were most commonly cholestatic (62.5%). None of the patients (0%) experienced acute postoperative HAT. On average, 22 and 25 months of postoperative follow-up was obtained for the adult and pediatric cohorts, respectively, and only one adult patient was found to have any liver-related complication. Conclusion A collaborative relationship between reconstructive microsurgeons and transplant surgeons mitigates the risk of HAT and improves patient outcomes in living donor liver transplantation.

show abstract

Microsurgical Procedures in Plastic Surgery

Marchi

Wei

2022

Textbook of Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

Microscope‐assisted hepatic artery reconstruction in adult living donor liver transplantation—A review of 325 consecutive cases in a single center

Abstract: Our study showed that the occurrence of HAT is avoidable. Identifying risk factors associated with HAT, meticulous surgical techniques, and careful routine flow monitoring are mandatory to avoid disastrous complications.

Cited by 20 publications

References 17 publications

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Analysis of Outcomes in Living Donor Liver Transplants Involving Reconstructive Microsurgeons

Microsurgical Procedures in Plastic Surgery

Contact Info

Product

Resources

About