LAPAROSCOPY-ASSISTED DONOR HEPATECTOMY

Abstract

A160 Aims: To establish the procedure for laparoscopy-assisted donor hepatectomy both in minimally invasive and safe way. Methods: We selected a 29 y/o mother of an 8 m/o boy with biliary atresia as a living donor to provide the lateral segment graft to be resected through the minimum access. We started the donor surgery by placing a flexible laparoscope through a 12mm trocar on the upper navel incision under pneumoperitoneum. Two 12mm and two 5mm trocars were placed in the sub costal area bilaterally. The lateral segment was fully mobilized by dividing attachments of the liver, then preparation of the roots of the left hepatic vein, the cystic duct, the left hepatic artery, the left portal vein, and the left hepatic duct was precisely done under laparoscopic view as much as possible. The gall bladder was removed after placing a catheter into the cystic duct for intra-operative cholangiogram. Before starting liver resection, pneumoperitoneum was quitted to avoid possible CO2 embolism through the cut surface of the liver. A 7cm of median mini-laparotomy was made beneath the xiphoid process by introducing the wall lifting method for laparoscopic view. After performing intra-operative ultrasonogram to identify all the major vessels and bile ducts, we started liver resection through the mini-laparotomy with a bipolar coagulating forceps and an ultrasonic dissector by having blood inflow into the graft. All the vessels and bile dusts appeared on the cut surface of the liver were ligated and divided directly through the mini-laparotomy. We completed preparation of the roots of the left hepatic vein, the left hepatic artery, the left portal vein, and the left hepatic duct through the mini-laparotomy under direct vision along with laparoscopic view. After having intra-operative cholangiogram, we divided the root of the left hepatic duct and sutured the cut end through the mini-laparotomy. Then, the lateral segment graft was fully separated in connection only with the left hepatic vein, the left hepatic artery, and the left portal vein. After placing vessel clamps and dividing all these vessels through the mini-laparotomy, we retrieved the lateral segment graft and started perfusion of the graft ex situ. The graft was implanted into the recipient after perfusion. The roots of the all vessels were closed directly through the mini-laparotomy. We completed laparoscopy-assisted donor hepatectomy by placing a drainage tube along the cut surface of the liver after confirming no bleeding and no bile leakage. We compared the operative result of this laparoscopy-assisted donor lateral segmentectomy with that of twenty-nine open donor lateral segmentectomy done from April 1995 to March 2004 at our institute. Results: The procedure of the laparoscopy-assisted donor hepatectomy was smooth and uneventful. The operative time was 510 minutes (mean of open surgery: 368 minutes, ranging from 266 to 459 minutes). The blood loss was 70 ml (mean of open surgery: 252 ml, ranging from uncountable to 790 ml). The donor started oral intake on the next day of the surgery and went back home on the eighth post-operative day without having any complication. The mean hospital stay after open surgery was 15 days, ranging from 9 to 45 days. The size of the graft was 248 g and the graft function was well in the recipient. The recipient had no complication related to the graft surgery including primary graft non-function, hepatic artery thrombosis, and bile leakage from the cut surface of the liver. Conclusions: We have established safe and minimally invasive donor hepatectomy to minimize the burden imposed on a living donor.