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Cherqui D, Ciria R, Kwon CHD, Kim KH, Broering D, Wakabayashi G, Samstein B, Troisi RI, Han HS, Rotellar F, Soubrane O, Briceño J, Alconchel F, Ayllón MD, Berardi G, Cauchy F, Luque IG, Hong SK, Yoon YY, Egawa H, Lerut J, Lo CM, Rela M, Sapisochin G, Suh KS. Expert Consensus Guidelines on Minimally Invasive Donor Hepatectomy for Living Donor Liver Transplantation From Innovation to Implementation: A Joint Initiative From the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA). Ann Surg 2021; 273:96-108. [PMID: 33332874 DOI: 10.1097/sla.0000000000004475] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Expert Consensus Guidelines initiative on MIDH for LDLT was organized with the goal of safe implementation and development of these complex techniques with donor safety as the main priority. BACKGROUND Following the development of minimally invasive liver surgery, techniques of MIDH were developed with the aim of reducing the short- and long-term consequences of the procedure on liver donors. These techniques, although increasingly performed, lack clinical guidelines. METHODS A group of 12 international MIDH experts, 1 research coordinator, and 8 junior faculty was assembled. Comprehensive literature search was made and studies classified using the SIGN method. Based on literature review and experts opinions, tentative recommendations were made by experts subgroups and submitted to the whole experts group using on-line Delphi Rounds with the goal of obtaining >90% Consensus. Pre-conference meeting formulated final recommendations that were presented during the plenary conference held in Seoul on September 7, 2019 in front of a Validation Committee composed of LDLT experts not practicing MIDH and an international audience. RESULTS Eighteen Clinical Questions were addressed resulting in 44 recommendations. All recommendations reached at least a 90% consensus among experts and were afterward endorsed by the validation committee. CONCLUSIONS The Expert Consensus on MIDH has produced a set of clinical guidelines based on available evidence and clinical expertise. These guidelines are presented for a safe implementation and development of MIDH in LDLT Centers with the goal of optimizing donor safety, donor care, and recipient outcomes.
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Affiliation(s)
- Daniel Cherqui
- AP-HP, Hepatobiliary Center, Paul Brousse Hospital, Université Paris Saclay, Villejuif, France
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation. University Hospital Reina Sofía, Cordoba, Spain
| | - Choon Hyuck David Kwon
- Department of General Surgery, Digestive Disease & Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dieter Broering
- Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Al Faisal University, Riyadh, KSA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Benjamin Samstein
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, New York
| | - Roberto I Troisi
- Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Al Faisal University, Riyadh, KSA
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Department of Human Structure and Repair, Ghent University, Belgium
| | - Ho Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fernando Rotellar
- Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Olivier Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation. University Hospital Reina Sofía, Cordoba, Spain
| | - Felipe Alconchel
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - María Dolores Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation. University Hospital Reina Sofía, Cordoba, Spain
| | - Giammauro Berardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Department of Human Structure and Repair, Ghent University, Belgium
| | - Francois Cauchy
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Irene Gómez Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation. University Hospital Reina Sofía, Cordoba, Spain
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Yin Yoon
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
| | - Jan Lerut
- Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels, Belgium
| | - Chung-Mau Lo
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Center, Bharat Institute of Higher Education and Research, Chennai, India
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Gonzalo Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Wei Chieh AK, Chan A, Rotellar F, Kim KH. Laparoscopic major liver resections: Current standards. Int J Surg 2020; 82S:169-177. [PMID: 32652295 DOI: 10.1016/j.ijsu.2020.06.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
Laparoscopic liver resection was slow to be adopted in the surgical arena at the beginning as there were major barriers including the fear of gas embolism, risk of excessive blood loss from the inability to control bleeding vessels effectively, suboptimal surgical instruments to perform major liver resection and the concerns about oncological safety of the procedure. However, it has come a long way since the early 1990s when the first successful laparoscopic liver resection was performed, spurring liver surgeons worldwide to start exploring the roles of laparoscopy in major liver resections. Till date, more than 9000 cases have been reported in the literature and the numbers continue to soar as the hepatobiliary surgical communities quickly learn and apply this technique in performing major liver resection. Large bodies of evidence are available in the literature showing that laparoscopic major liver resection can confer improved short-term outcomes in terms of lesser operative morbidities, lesser operative blood loss, lesser post-operative pain and faster recovery with shorter length of hospitalization. On the other hand, there is no compromise in the long-term and oncological outcomes in terms of comparable R0 resection rate and survival rates of this approach. Many innovations in laparoscopic major hepatectomies for complex operations have also been reported. In this article, we highlight the journey of laparoscopic major hepatectomies, summarize the technical advancement and lessons learnt as well as review the current standards of outcomes for this procedure.
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Affiliation(s)
- Alfred Kow Wei Chieh
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, National University of Singapore, Singapore
| | - Albert Chan
- State Key Laboratory for Liver Research, Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, China
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and Ulsan University, Seoul, Republic of Korea.
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Kwon CHD, Choi GS, Kim JM, Cho CW, Rhu J, Soo Kim G, Sinn DH, Joh JW. Laparoscopic Donor Hepatectomy for Adult Living Donor Liver Transplantation Recipients. Liver Transpl 2018; 24:1545-1553. [PMID: 30021060 DOI: 10.1002/lt.25307] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
Even after 2 decades of experience in laparoscopic hepatectomy, data on purely laparoscopic approach for donor hepatectomy in adult living donor liver transplantation (LDLT) are limited. We report our initial experience of a purely laparoscopic approach for donor hepatectomy for adult recipients to explore its potential application in the management of donors. We did a retrospective data analysis of 54 consecutive patients operated on between May 2013 and February 2015. There were 41 right, 10 extended right, and 3 left hepatectomies. The median operative time was 436 minutes (range 294-684 minutes), and warm ischemia time was 6 minutes (2-12 minutes). Estimated blood loss was 300 mL (10-850 mL), and none of the patients required intraoperative transfusion. Four cases were converted to open laparotomy. The major complication rate was 16.7%, and biliary complication was the most frequent cause. Patients with normal anatomy had a major complication rate of 9.3% as compared with 45.5% in patients with anatomic variations. All patients recovered, and there was no mortality. In conclusion, a purely laparoscopic donor hepatectomy for adult LDLT recipients seems to be a feasible option; with careful patient selection and when performed by experienced surgeons, it may afford results comparable to the open method.
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Affiliation(s)
- Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Transplant Center, Mayo Clinic, Rochester, MN
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Woo Cho
- Department of Surgery, Yeungnam University School of Medicine and College of Medicine, Daegu, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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One Hundred Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center. Transplantation 2018; 102:1878-1884. [DOI: 10.1097/tp.0000000000002229] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Au KP, Chok KSH. Minimally invasive donor hepatectomy, are we ready for prime time? World J Gastroenterol 2018; 24:2698-2709. [PMID: 29991875 PMCID: PMC6034150 DOI: 10.3748/wjg.v24.i25.2698] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/25/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery potentially reduces operative morbidities. However, pure laparoscopic approaches to donor hepatectomy have been limited by technical complexity and concerns over donor safety. Reduced-wound donor hepatectomy, either in the form of a laparoscopic-assisted technique or by utilizing a mini-laparotomy wound, i.e., hybrid approach, has been developed to bridge the transition to pure laparoscopic donor hepatectomy, offering some advantages of minimally invasive surgery. To date, pure laparoscopic donor left lateral sectionectomy has been validated for its safety and advantages and has become the standard in experienced centres. Pure laparoscopic approaches to major left and right liver donation have been reported for their technical feasibility in expert hands. Robotic-assisted donor hepatectomy also appears to be a valuable alternative to pure laparoscopic donor hepatectomy, providing additional ergonomic advantages to the surgeon. Existing reports derive from centres with tremendous experience in both laparoscopic hepatectomy and donor hepatectomy. The complexity of these procedures means an arduous transition from technical feasibility to reproducibility. Donor safety is paramount in living donor liver transplantation. Careful donor selection and adopting standardized techniques allow experienced transplant surgeons to safely accumulate experience and acquire proficiency. An international prospective registry will advance the understanding for the role and safety of pure laparoscopic donor hepatectomy.
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Affiliation(s)
- Kin Pan Au
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Kenneth Siu Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
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Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, Yoon KC, Choi JY, Oh D, Kim H. Pure laparoscopic living donor hepatectomy: Focus on 55 donors undergoing right hepatectomy. Am J Transplant 2018; 18:434-443. [PMID: 28787763 DOI: 10.1111/ajt.14455] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Although laparoscopic donor hepatectomy is increasingly common, few centers with substantial experience have reported the results of pure laparoscopic donor right hepatectomy (PLDRH). Here, we report the experiences of 60 consecutive liver donors undergoing pure laparoscopic donor hepatectomy (PLDH), with most undergoing right hepatectomy. None of the 60 donors who underwent PLDH had intraoperative complications and none required transfusions, reoperation, or conversion to open hepatectomy. Forty-five donors who underwent PLDRH between November 2015 and December 2016 were compared with 42 who underwent conventional donor right hepatectomy (CDRH) between May 2013 and February 2014. The total operation time was longer (330.7 vs 280.0 minutes; P < .001) and the percentage with multiple bile duct openings was higher (53.3% vs 26.2%; P = .010) in the PLDRH group. However, the length of postoperative hospital stay (8.4 vs 8.2 days; P = .495) and rate of complications (11.9% vs 8.9%; P = .733) and re-hospitalizations (4.8% vs 4.4%; P = 1.000) were similar in both groups. PLDH, including PLDRH, is feasible when performed by a highly experienced surgeon and transplant team. Further evaluation, including long-term results, may support these preliminary findings of comparative outcomes for donors undergoing PLDRH and CDRH.
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Affiliation(s)
- K S Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - S K Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - K W Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - N J Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - H S Kim
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - S W Ahn
- Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea
| | - K C Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - J Y Choi
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - D Oh
- Department of Surgery, Myongji Hospital, Gyeonggi-do, Korea
| | - H Kim
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
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Li J, Huang J, Wu H, Zeng Y. Laparoscopic living donor right hemihepatectomy with venous outflow reconstruction using cadaveric common iliac artery allograft: Case report and literature review. Medicine (Baltimore) 2017; 96:e6167. [PMID: 28207553 PMCID: PMC5319542 DOI: 10.1097/md.0000000000006167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 02/05/2023] Open
Abstract
RATIONALE With the development of laparoscopic technique, the total laparoscopic living donor right hemihepatectomy (LLDRH) procurement surgery has been successfully performed in many liver transplant centers all over the world, and the number of cases is continuing to increase. We report our case of laparoscopic right graft resection with venous outflow reconstruction using cadaveric common iliac artery allograft in our center and review literatures about total LLDRH surgery. PATIENT CONCERNS AND DIAGNOSES A 40-year-old male living donor for right hepatectomy was selected after pretransplant evaluation including laboratory tests, liver volume, anatomy of hepatic vein, artery, portal vein, and bile duct. Living donor liver transplantation surgery was approved by Sichuan Provincial Health Department and the ethics committee of the West China Hospital, Sichuan University. INTERVENTIONS Hepatic parenchyma transection was performed by ultrasonic scalpel and Cavitron Ultrasonic Surgical Aspirator (CUSA). Right branch of portal vein, right hepatic artery, right hepatic duct, and right hepatic vein were meticulously dissected. The right hepatic duct was ligated and transected 2 mm far from the bifurcation of common hepatic duct, right hepatic artery, and portal vein were also ligated and transected, the right hepatic vein was transected by laparoscopic linear cutting stapler. The gap between short hepatic veins and right hepatic vein was bridged and reconstructed by cadaveric common iliac artery allograft. OUTCOMES The operation time was 480 minutes and warm ischemia time was 4 minutes. Blood loss was 300 mL without blood transfusion. The donor was discharged on postoperative day 7 uneventfully without complications. Literatures about laparoscopic living donor right hemihepatectomy are compared and summarized in table. LESSONS The total laparoscopic living donor right hemihepatectomy is technically feasible and safe in some transplant centers which should have rich open living donor liver transplantation experience and skilled laparoscopic techniques. Venous outflow tract reconstruction is necessary if orifice diameter of short hepatic vein is greater than 0.5 cm on the graft cutting surface.
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Hori T, Kaido T, Iida T, Yagi S, Uemoto S. Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision. Ann Gastroenterol 2016; 30:118-126. [PMID: 28042248 PMCID: PMC5198236 DOI: 10.20524/aog.2016.0088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A 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. METHODS We 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. RESULTS Preoperative 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. CONCLUSION LDLT surgeons have a very broad intellectual and technical frontier.
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Affiliation(s)
- Tomohide Hori
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshimi Kaido
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Taku Iida
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shintaro Yagi
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Uemoto
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
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Nadalin S, Capobianco I, Panaro F, Di Francesco F, Troisi R, Sainz-Barriga M, Muiesan P, Königsrainer A, Testa G. Living donor liver transplantation in Europe. Hepatobiliary Surg Nutr 2016; 5:159-75. [PMID: 27115011 DOI: 10.3978/j.issn.2304-3881.2015.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Living donor liver transplantation (LDLT) sparked significant interest in Europe when the first reports of its success from USA and Asia were made public. Many transplant programs initiated LDLT and some of them especially in Germany and Belgium became a point of reference for many patients and important contributors to the advancement of the field. After the initial enthusiasm, most of the European programs stopped performing LDLT and today the overall European activity is concentrated in a few centers and the number of living donor liver transplants is only a single digit fraction of the overall number of liver transplants performed. In this paper we analyse the present European activities and highlight the European contribution to the advancement of the field of LDLT.
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Affiliation(s)
- Silvio Nadalin
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Ivan Capobianco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Panaro
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Di Francesco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Roberto Troisi
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Mauricio Sainz-Barriga
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Paolo Muiesan
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Alfred Königsrainer
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Giuliano Testa
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
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Bekheit M, Khafagy PA, Bucur P, Katri K, Elgendi A, Abdel-Salam WN, Vibert E, El-Kayal ES. Donor safety in live donor laparoscopic liver procurement: systematic review and meta-analysis. Surg Endosc 2015; 29:3047-3064. [PMID: 25552233 DOI: 10.1007/s00464-014-4045-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Donor safety is a major concern in live organ donation. Live donor laparoscopic liver procurement is an advanced surgical procedure that is performed in highly specialized centers. Since its first report, not much progress has been endeavored for that procedure. METHODS We planned to include all the randomized and comparative nonrandomized studies. Patients' population: live donors who are submitted to organ procurement via laparoscopy. RESULTS Out of 5,636 records retrieved from the literature, only seven nonrandomized studies were included in this review, which encompassed 418 patients, 151 patients of whom underwent laparoscopic procurement. The quality scores for the included studies ranged from 66 to 76 %. The operative time was significantly shorter in the conventional open group (SD = 0.863, 95 % CI 0.107-1.819). Blood loss in the laparoscopic group was comparable with the conventional open approach (SD = -0.307, 95 % CI -0.807 to 0.192). In subgroup analysis, laparoscopy was protective against blood loss in laparoscopic parenchymal dissection (SD = -1.168, 95 % CI -1.758 to -0.577). The hospital stay was equal in both groups. Patients in laparoscopic group consumed fewer analgesics compared with conventional open group (SD = -0.33, 95 % CI -0.63 to -0.03). Analgesics use was lower in the laparoscopic group compared with the conventional approach. The rate of Clavien complications was equal in both groups (OR 0.721, 95 % CI 0.303-1.716). No difference was found between subgroup analysis based on the harvested liver lobe. Funnel plot and statistical methods used revealed low probability of publication BIAS. CONCLUSIONS 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.
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Affiliation(s)
- Mohamed Bekheit
- Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt.
- CIRE Plateform, INRA Centre Val de Loire, 37380, Nouzilly, France.
- INSERM, Unit 785, Centre Hepatobiliaire, Paul Brousse Hospital, 94804, Villejuif, France.
| | | | - Petru Bucur
- INSERM, Unit 785, Centre Hepatobiliaire, Paul Brousse Hospital, 94804, Villejuif, France
| | - Khaled Katri
- HPB Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria Main University Hospitals, Alexandria University, Alexandria, Egypt
| | - Ahmed Elgendi
- HPB Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria Main University Hospitals, Alexandria University, Alexandria, Egypt
| | - Wael Nabil Abdel-Salam
- HPB Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria Main University Hospitals, Alexandria University, Alexandria, Egypt
| | - Eric Vibert
- INSERM, Unit 785, Centre Hepatobiliaire, Paul Brousse Hospital, 94804, Villejuif, France
| | - El-Said El-Kayal
- HPB Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria Main University Hospitals, Alexandria University, Alexandria, Egypt
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Park JI, Kim KH, Lee SG. Laparoscopic living donor hepatectomy: a review of current status. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:779-88. [PMID: 26449392 DOI: 10.1002/jhbp.288] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the last two decades, laparoscopic surgery has been adopted in various surgical fields. Its advantages of reduced blood loss, reduced postoperative morbidity, shorter hospital stay, and excellent cosmetic outcome compared with conventional open surgery are well validated. In comparison with other abdominal organs, laparoscopic hepatectomy has developed relatively slowly due to the potential for massive bleeding, technical difficulties and a protracted learning curve. Furthermore, applications to liver graft procurement in living donor liver transplantation (LDLT) have been delayed significantly due to concerns about donor safety, graft outcome and the need for expertise in both laparoscopic liver surgery and LDLT. Now, laparoscopic left lateral sectionectomy in adult-to-pediatric LDLT is considered the standard of care in some experienced centers. Currently, the shift in application has been towards left lobe and right lobe graft procurement in adult LDLT from left lateral section in pediatric LDLT. However, the number of cases is too small to validate the safety and reproducibility. The most important concern in LDLT is donor safety. Even though a few studies reported the technical feasibility and comparable outcomes to conventional open surgery, careful validating through larger sample sized studies is needed to achieve standardization and wide application.
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Affiliation(s)
- Jeong-Ik Park
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea e-mail:
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea e-mail:
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Cauchy F, Schwarz L, Scatton O, Soubrane O. Laparoscopic liver resection for living donation: Where do we stand? World J Gastroenterol 2014; 20:15590-15598. [PMID: 25400442 PMCID: PMC4229523 DOI: 10.3748/wjg.v20.i42.15590] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 09/05/2014] [Indexed: 02/07/2023] Open
Abstract
In Western countries, living donor liver transplantation (LDLT) may represent a valuable alternative to deceased donor liver transplantation. Yet, after an initial peak of enthusiasm, reports of high rates of complications and of fatalities have led to a certain degree of reluctance towards this procedure especially in Western countries. As for living donor kidney transplantation, the laparoscopic approach could improve patient’s tolerance in order to rehabilitate this strategy and reverse the current trend. In this setting however, initial concerns regarding patient’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation and lack of evidence supporting the benefits of laparoscopy have delayed the development of this approach. Similarly to what is performed in classical resectional liver surgery, initial experiences of laparoscopy have therefore begun with left lateral sectionectomy, which is performed for adult to child living donation. In this setting, the laparoscopic technique is now well standardized, is associated with decreased donor blood loss and hospital stays and provides graft of similar quality compared to the open approach. On the other hand laparoscopic major right or left hepatectomies for adult-adult LDLT currently lack standardization and various techniques such as the full laparoscopic approach, the hand assisted approach and the hybrid approach have been reported. Hence, even-though several reports highlight the feasibility of these procedures, the true benefits of laparoscopy over laparotomy remain to be fully assessed. This could be achieved through standardization of the procedures and creation of international registries especially in Eastern countries where LDLT keeps on flourishing.
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