Detailed Abstract
[E-poster - Liver (Transplantation)]
[EP 036] Improvements in Surgical Techniques for Laparoscopic Liver Donor Right Hemihepatectomy
Xiang LAN1, Jianguo QIU1, Heng XIAO1, Kai CHEN1, Qiang HE1, Fufu WEI1, Zhu CHEN1, Haiyang HU1, Chenyou DU1
1Department of Liver Transplantation and Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, China
Background : Laparoscopic liver donor right hemihepatectomy (LLDRH) for living donor liver transplantation has been performed routinely at several transplant centers. Here, we report improvements in surgical techniques for patients with LLDRH,which can simplify surgical procedures and shorten the learning curve.
Methods : The data of donors who underwent LLDRH at our center were studied retrospectively. The improvements in surgical techniques include the following: 1. The anatomy of the first porta hepatis followed the principle of “extra-Glissonian sheath first and then intra-Glissonian sheath”; 2. Instead of the liver hanging maneuver, the caudate lobe was transected along the ventral side of the inferior vena cava (IVC) by utilizing the avascular area of the IVC; 3. Instead of cholangiography, indocyanine green (ICG) fluorescence guidance was performed to identify the bifurcation of the bile duct; 4. A handmade one-sided staple of PVS was used to increase the free-end length of the graft’s right hepatic vein (RHV); 5. The recanalization round ligament was used to reconstruct the V5v.
Results : Novel surgical techniques were used in two LLDRH donors. The operative times were 230 min and 260 min, respectively. The blood loss was 50 ml and 100 ml. The warm-ischemic times were 5 min and 6 min. The free end lengths of the RHV were 1.3 cm and 1.1 cm. The new method of accessing the first porta hepatis could help us dissect the right hepatic duct quickly and identify the bile duct more easily under ICG guidance. The graft’s RHV, addressed by our handmade one-sided staple, could be anastomosed to the IVC directly.
Conclusions : This novel technique can reduce surgical difficulty for both donors and recipients, shorten the learning curve and increase the safety of the donor.
Methods : The data of donors who underwent LLDRH at our center were studied retrospectively. The improvements in surgical techniques include the following: 1. The anatomy of the first porta hepatis followed the principle of “extra-Glissonian sheath first and then intra-Glissonian sheath”; 2. Instead of the liver hanging maneuver, the caudate lobe was transected along the ventral side of the inferior vena cava (IVC) by utilizing the avascular area of the IVC; 3. Instead of cholangiography, indocyanine green (ICG) fluorescence guidance was performed to identify the bifurcation of the bile duct; 4. A handmade one-sided staple of PVS was used to increase the free-end length of the graft’s right hepatic vein (RHV); 5. The recanalization round ligament was used to reconstruct the V5v.
Results : Novel surgical techniques were used in two LLDRH donors. The operative times were 230 min and 260 min, respectively. The blood loss was 50 ml and 100 ml. The warm-ischemic times were 5 min and 6 min. The free end lengths of the RHV were 1.3 cm and 1.1 cm. The new method of accessing the first porta hepatis could help us dissect the right hepatic duct quickly and identify the bile duct more easily under ICG guidance. The graft’s RHV, addressed by our handmade one-sided staple, could be anastomosed to the IVC directly.
Conclusions : This novel technique can reduce surgical difficulty for both donors and recipients, shorten the learning curve and increase the safety of the donor.
SESSION
E-poster
E-Session 03/21 ALL DAY