Pure laparoscopic donor right hepatectomy: perspectives in manipulating a flexible scope

Hong, Suk Kyun; Shin, Eunhye; Lee, Kwang Woong; Yoon, Kyung Chul; Lee, Jeong Moo; Cho, Jaehyung; Yi, Nam Joon; Suh, Kyung Suk

doi:10.1007/s00464-018-6594-1

Cited by 21 publications

(14 citation statements)

References 16 publications

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“…The search strategy identified a number of studies from the same centres with overlapping data, majority of them from Korean centres. The two centres with multiple overlapping publications were Seoul National University Hospital (SNUH)[ 25 26 27 28 29 30 31 32 ] and Samsung Medical Centre (SMC). [ 33 34 35 36 ] Two multicenter studies, one from the West[ 37 ] and one from the East[ 14 ] compiled data from multiple centres.…”

Section: Resultsmentioning

confidence: 99%

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation – A systematic review and meta-analysis

Papoulas

Hakeem

Heaton

et al. 2022

Journal of Minimal Access Surgery

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Background: Pure laparoscopic donor hepatectomy (PLDH) for adult living donor liver transplantation (LDLT) remains controversial. The aim of this study was to undertake a systematic review and meta-analysis of donor outcomes following PLDH for adult LDLT. Materials and Methods: Systematic review in line with the meta-analysis of observational studies in epidemiology guidelines. Results: Eight studies were included in the systematic review and six in the meta-analysis. A total of 575 donors underwent PLDH for adult LDLT. The mean donor age was 32.8 years with a BMI of 23.4 kg/m 2 and graft weight of 675 g. The mean operative time was 353 min and the conversion rate was 2.8% ( n = 16). Overall morbidity was 10.8% with 1.6% major complications (Clavien-Dindo grade 3b), zero mortality and 9.0 days length of stay (LOS). The meta-analysis demonstrated that the operative time was significantly shorter for the open donor hepatectomy group (mean difference 29.15 min; P = 0.006) and the LOS was shorter for the PLDH group (mean difference −0.73 days; P = 0.02), with a trend towards lesser estimated blood loss in PLDH group. However, no difference between the two groups was noted in terms of overall morbidity or major complications. Conclusions: Perioperative outcomes of PLDH are similar to the standard open approach in highly specialised centers with trend towards lesser blood loss and overall shorter hospital stay. Careful donor selection and standardisation of the technique are imperative for the successful implementation and adoption of the procedure worldwide.

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Section: Resultsmentioning

confidence: 99%

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation – A systematic review and meta-analysis

Papoulas

Hakeem

Heaton

et al. 2022

Journal of Minimal Access Surgery

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“…Second, the da Vinci system utilizes a rigid 3D telescope. This limits the approach to the superior and posterior portions of the liver, in contrast to the flexible 3D imaging system used in laparoscopic surgery, which is useful for operating in a limited space, especially during liver mobilization and deep parenchymal transection (44). Despite these limitations, from our initial experience, RH might be considered as a feasible procedure in the liver resection, even in major hepatectomy.…”

Section: Discussionmentioning

confidence: 98%

Initial experience with a robotic hepatectomy program at a high-volume laparoscopic center: single-center experience and surgical tips

Lee

Choi²,

Cho

et al. 2021

Ann Transl Med

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Background: Despite the development of laparoscopic surgery, there are still inherent limitations associated with conventional laparoscopic instruments such as restrictions in movement and an inability for articulation. Robotic surgery may help to overcome the limitations of conventional laparoscopic surgery. The aim of this study was to present our initial experience with robotic hepatectomy (RH) and discuss the steps required to develop an RH program at a high-volume laparoscopic hepatectomy (LH) center. Methods: We retrospectively reviewed prospectively collected data for 14 consecutive patients who underwent RH between 2017 and 2018. Clinicopathological characteristics and perioperative outcomes were compared with those reported in previous studies. The operation time of each procedure was analyzed to assess RH proficiency based on experience. Results: Of the 14 patients, 12 patients (85.7%) underwent robotic major hepatectomy. Median patient age was 54.5 years, while median body mass index (BMI) was 25.2 kg/m 2 . The median operation time was 360 (range: 145-544) min. The median estimated blood loss (EBL) was 300 (range: 50-1,400) mL. Conversion to open surgery was not required in any case. The median length of hospital stay was 5 (range: 4-14) days.Major complications occurred in 2 patients (14.2%), although both recovered without sequelae. The time required for hilar dissection, docking, and parenchymal transection gradually decreased after the first two cases of RH.Conclusions: From our initial experience, RH might be considered as a feasible procedure in the liver resection, even in major hepatectomy. In addition, surgeons with sufficient experience in LH could rapidly adapt for RH. However, we have to make a system for education and monitoring of this innovative surgery for the patients' safety.

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“…The type of laparoscope is also very important for PLDRH starters. Many high-volume centers favor a 3-dimensional (3D) flexible endoscope over a rigid endoscope due to the flexibility of the camera angle and depth of perception [ 19 ]. However, our team solely uses a 30-degree, 2-dimensional (2D) ICG endoscope for PLDRH for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

et al. 2022

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Background Pure laparoscopic donor right hepatectomy (PLDRH) can provide better operative outcomes for the donor than conventional open donor right hepatectomy (CODRH). However, the complexity of the procedure typically makes transplant teams reluctant to perform it, especially in low-volume transplant centers. We compared the outcomes of PLDRH and CODRH to demonstrate the feasibility of PLDRH in a low-volume transplant program. Methods We carried out a retrospective study of adult living donor liver transplantation in Chiang Mai University Hospital from January 2015 to March 2021. The patients were divided into a PLDRH group and a CODRH group. Baseline characteristics, operative parameters, and postoperative complications of donors and recipients were compared between the two groups. Results Thirty patients underwent donor hepatectomy between the dates selected (9 PLDRH patients and 21 CODRH patients). The baseline characteristics of the 2 groups were not significantly different. The median graft volume of the PLDRH group was 693.8 mL, which was not significantly different from that of the CODRH group (726.5 mL) The PLDRH group had a longer operative time than the CODRH group, but the difference was not statistically significant (487.5 min vs 425.0 min, p = 0.197). The overall complication rate was not significantly different between the two groups (33.3% vs 22.2%, p = 0.555). Additionally, for the recipients, the incidence of major complications was not significantly different between the groups (71.3 vs 55.6%, p = 0.792). Conclusion Even in the context of this low-volume transplant program, whose staff have a high level of experience in minimally invasive hepatobiliary surgery, PLDRH showed similar results to CODRH in terms of perioperative outcomes for donors and recipients.

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Pure laparoscopic donor right hepatectomy: perspectives in manipulating a flexible scope

Cited by 21 publications

References 16 publications

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation – A systematic review and meta-analysis

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation – A systematic review and meta-analysis

Initial experience with a robotic hepatectomy program at a high-volume laparoscopic center: single-center experience and surgical tips

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

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