Anterior approach for pure laparoscopic donor right hepatectomy
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Anterior approach for pure laparoscopic donor right hepatectomy Yasushi Hasegawa1 · Hiroyuki Nitta1 · Takeshi Takahara1 · Hirokatsu Katagiri1 · Shoji Kanno1 · Akira Umemura1 · Akira Sasaki1 Received: 25 January 2020 / Accepted: 13 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Pure laparoscopic donor hepatectomy (PLDH) is being increasingly performed at centers with experienced surgeons [1–6]. This procedure is still developing and is associated with several challenges owing to its technical difficulty [7–9]. Conversely, the anterior approach is sometimes applied to both laparoscopic and open right hepatectomy for management of tumors in the liver [10, 11]. However, there are no reports regarding the use of the anterior approach for PLDH. We found this method to be useful; therefore, we aimed to introduce the novel procedure using a video clip. Methods The donor was placed in the supine position. First, the right side of the inferior vena cava was dissected instead of performing the liver hanging maneuver. The right Glissonean pedicle was encircled and controlled, and the liver parenchyma was completely transected. Thereafter, the ligaments around the liver were dissected, and the graft was mobilized. The hilar vessels were respectively separated. Finally, the right hepatic duct, right hepatic artery, right portal vein, and right hepatic vein were divided, and the graft liver was retrieved. This study was approved by institutional ethics board (MH2019-119), and informed consent was taken from the patient. Results The overall surgical time was 400 min, the volume of blood loss was 31 mL, the warm ischemic time was 7 min, and no complications were seen. Conclusion The advantages of the anterior approach for right-sided PLDH might be attribute to reduction of compression injury and incidence of subcapsular hematoma, as liver mobilization is easily performed because of increased liver mobility. However, PLDH is a highly-skilled procedure, and indications for PLDH should be extended in a step-wise manner. Further, the procedure should be performed only by highly proficient surgeons having extensive experience in both laparoscopic liver resection and living donor liver transplantation. Keywords Anterior approach · Donor · Hepatectomy · Laparoscopy · Liver transplantation
Compliance with ethical standards Acknowledgements We would like to thank the staff of the Department of Anesthesiology, Iwate Medical University for their assistance. We would like to thank Editage (www.editage.com) for English language editing.
Disclosures Drs. Yasushi Hasegawa, Hiroyuki Nitta, Takeshi Takahara, Hirokatsu Katagiri, Shoji Kanno, Akira Umemura, and Akira Sasaki have no conflicts of interest or financial ties to disclose.
References
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07649-7) contains supplementary material, which is available to authorized use
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