Laparoscopic-assisted donor hepatectomy: is it possible?, is it safe?

Barros Schelotto Pablo, Pfaffen Guillermo, Ramisch Diego, Padín Juan, Sandi Marcelo, Farinelli Pablo, Rumbo Carolina, Descalzi Valeria, Trentadue Julio, Niveiro Silvia, Raffa

Sebastián, Gondolesi Gabriel.

Laparoscopic liver resection has evolved in the last decade.

Favorable outcomes increased the interest to perform this technique in living donors for liver transplantation.

Few liver transplant centers have developed the laparoscopic living donor hepatectomy (LLDH)

Background

. • To present the first experience of video-assisted

hepatectomy in living donors for pediatric liver transplantation performed in 3 consecutive donors in Argentina

• To report safety and feasibility of the procedure.

Aim

1.Laparoscopic-assisted stage: includes liver mobilization, intraoperative cholangiography and doppler ultrasound, hepatic hilar and left hepatic vein dissection followed by the beginning of the parenchymal transection

2.Open stage: includes completion of the parenchymal transection throughout the hand port incision. Harvesting of the liver, suture of the remnant vascular and biliary stumps

Procedure

All were isogroup for blood type and had no biochemical abnormalities.

Anatomical evaluations were done on a 64 heads multi-detector CT scan

In the recipient a total hepatectomy with preservation of cava vein was performed.

Hepatic, portal, arterial and biliary Roux-Y reconstruction were performed in standard fashion.

.

Donors evaluation

Recipient

Results

Two left lateral segmentectomy and one left hepatectomy were performed.

The mean donor’s age was 31.3 years all donors were female.

All patients started oral intake on the

next day of surgery.

Case 1

LLS

Case 2

Left Hep.

Case 3

LLS

Mean

AST 45 U/L 131 U/L 177 U/L 117,33 U/L

ALT 105 U/L 264 U/L 127 U/L 165,33 U/L

Bilirubin 0,3 mg/dl 3 mg/dl 0,7 mg/dl 1,33 mg/dl

Operative time(Hs). 6 8 5 6,33

PACU 1 1 1 1

Postoperative stay 3 4 3 3,33

Results

.No donors had early or late complications after 14 m.

Video-assisted hepatectomy had the advantages of minimally invasive surgery.

Conclusion

Based on the results reported by international literature and the results presented in this series, we considerer that, LLDH might become the standard procedure in centers with experience in laparoscopic liver resection.