Ann Liver Transplant.  2023 Nov;3(2):94-99. 10.52604/alt.23.0015.

Analyzing bench-surgery time: A comparative study of pure laparoscopic and open left hepatectomy including the middle hepatic vein in living liver donors

• Hong SK
• Kim M
• Kim Y
• Kim JY
• Lee J
• Kim J
• Hong Sy
• Lee JM
• Choi Y
• Yi NJ
• Lee KW
• Suh KS

• KMID: 2560929
• DOI: http://doi.org/10.52604/alt.23.0015

Abstract

Background
Pure laparoscopic donor hepatectomy (PLDH) has garnered attention due to its potential advantages in donor cosmesis and functional outcomes. This study focuses on bench-surgery in pure laparoscopic donor left hepatectomy (PLDLH) and compares it with conventional donor left hepatectomy (CDLH).
Methods
We conducted a retrospective analysis of donor records, specifically comparing PLDLH, including the middle hepatic vein (MHV), performed from November 2015 to January 2018 with CDLH, including MHV, performed from August 2014 to September 2015. Key parameters examined encompassed bench-surgery time and the number of openings in the hepatic vein, portal vein, hepatic artery, and bile duct within the procured graft.
Results
PLDLH exhibited significantly longer bench-surgery time (45.0 vs. 24.0 min, p=0.028), liver removal time (244.5 vs. 177.0 min, p=0.038), and warm ischemic time (10.5 vs. 3.0 min, p<0.001) when compared to CDLH. However, graft weight and the number of openings in the hepatic vein, portal vein, hepatic artery, and bile duct were similar between the two groups.
Conclusion
This study objectively demonstrates that PLDLH requires a longer duration of bench-surgery than CDLH, suggesting the necessity for additional steps during bench-surgery. It emphasizes the crucial role of a skilled surgical team in both bench-surgery and recipient surgery for the successful execution of PLDLH and achieving recipient outcomes comparable to those of CDLH.

Keyword

Liver transplantation; Living donors; Hepatectomy; Laparoscopy; Transplants

Figure

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  Figure 1 Bench-surgery time comparison between CDLH and PLDLH. PLDLH, pure laparoscopic donor left hepatectomy; CDLH, conventional donor left hepatectomy.

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  Figure 2 Correlation between (A) operative time, (B) liver removal time, (C) warm ischemic time, and (D) bench-surgery time in relation to the progressive performance of pure laparoscopic donor left hepatectomy.

Reference

1. Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, et al. 2002; Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet. 359:392–396. DOI: 10.1016/S0140-6736(02)07598-0. PMID: 11844509.

2. Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, et al. World Consensus Conference on Laparoscopic Surgery. 2009; The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg. 250:825–830. DOI: 10.1097/SLA.0b013e3181b3b2d8. PMID: 19916210.

3. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. 2015; Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 261:619–629.

4. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, et al. 2018; The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 268:11–18. DOI: 10.1097/SLA.0000000000002524. PMID: 29064908.

5. Cherqui D, Ciria R, Kwon CHD, Kim KH, Broering D, Wakabayashi G, et al. 2021; 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. 273:96–108. DOI: 10.1097/SLA.0000000000004475. PMID: 33332874.

6. Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, et al. 2018; Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant. 18:434–443. DOI: 10.1111/ajt.14455. PMID: 28787763.

7. Hong SK, Tan MY, Worakitti L, Lee JM, Cho JH, Yi NJ, et al. 2022; Pure laparoscopic versus open right hepatectomy in live liver donors: a propensity score-matched analysis. Ann Surg. 275:e206–e212. DOI: 10.1097/SLA.0000000000003914. PMID: 32324692.

8. Hong SK, Kim JY, Lee J, Kim J, Choi HH, Lee S, et al. 2023; Pure laparoscopic donor hepatectomy: experience of 556 cases at Seoul National University Hospital. Am J Transplant. https://doi.org/10.1016/j.ajt.2023.06.007 [Epub ahead of print]. DOI: 10.1016/j.ajt.2023.06.007.

9. Hong K, Hong SK, Han ES, Suh S, Hong SY, Lee JM, et al. 2021; Pure laparoscopic vs. open right hepatectomy in living liver donors: bench-surgery time. Front Surg. 8:771026. DOI: 10.3389/fsurg.2021.771026. PMID: 34888346. PMCID: PMC8649712.

10. Hong SK, Suh KS, Kim KA, Lee JM, Cho JH, Yi NJ, et al. 2020; Pure laparoscopic versus open left hepatectomy including the middle hepatic vein for living donor liver transplantation. Liver Transpl. 26:370–378. DOI: 10.1002/lt.25697. PMID: 31808294.

11. Yi NJ, Suh KS, Cho JY, Lee HW, Cho EH, Yang SH, et al. 2007; Three-quarters of right liver donors experienced postoperative complications. Liver Transpl. 13:797–806. DOI: 10.1002/lt.21030. PMID: 17539000.

12. Suh KS, Suh SW, Lee JM, Choi Y, Yi NJ, Lee KW. 2015; Recent advancements in and views on the donor operation in living donor liver transplantation: a single-center study of 886 patients over 13 years. Liver Transpl. 21:329–338. DOI: 10.1002/lt.24061. PMID: 25488794.

13. Hong SK, Suh KS, Yoon KC, Lee JM, Cho JH, Yi NJ, et al. 2019; The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis. Surg Endosc. 33:3741–3748. DOI: 10.1007/s00464-019-06668-3. PMID: 30771071.

14. Han ES, Lee KW, Suh KS, Yi NJ, Choi Y, Hong SK, et al. 2021; Shorter operation time and improved surgical outcomes in laparoscopic donor right hepatectomy compared with open donor right hepatectomy. Surgery. 170:1822–1829. DOI: 10.1016/j.surg.2021.06.005. PMID: 34256932.

15. Lee SG. 2006; Techniques of reconstruction of hepatic veins in living-donor liver transplantation, especially for right hepatic vein and major short hepatic veins of right-lobe graft. J Hepatobiliary Pancreat Surg. 13:131–138. DOI: 10.1007/s00534-005-1019-7. PMID: 16547674.