Laparoscopic left lateral sectionectorny in living donors - Safety and reproducibility of the technique in a single center
Laparoscopic left lateral sectionectorny in living donors - Safety and reproducibility of the technique in a single center
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DOI：
10.1097/01.sla.0000218059.31231.b6
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发表时间：
2006-11-01
影响因子：
9
通讯作者：
Gauthier, Frederic
中科院分区：
文献类型：
--
作者：
Soubrane, Olivier;Cherqui, Daniel;Gauthier, Frederic
背景数据和目的：通过腹腔镜进行的儿童肝移植左外侧部分切除术是一种创新的手术，它是根据我们在腹腔镜肝切除和活体供体移植物收获方面的经验而开发的。主要目标是在保留腹壁的同时尽量减少供体发病率。在此，我们报告的技术可行性和可重复性，并比较它与开放式肝切除术（OLR）。方法：16个连续的捐助者进行了腹腔镜肝切除术（LLR）从2001年至2005年。他们与其他14名在第一阶段（1998-2004年）接受标准开放式肝切除术（OLR）的供体进行了比较。首先，本报告描述了腹腔镜切除术的技术特点。第二，围手术期发病率和移植物的特点进行了比较，根据使用或不腹腔镜approach.Results：腹腔镜收获成功地进行了15 16例在意向治疗的基础上。需要进行一次转换，以确保椎弓根剥离期间发生的左门静脉损伤的腹腔镜修复质量。未观察到与腹腔镜相关的特殊并发症。与OLR相比，手术时间更长（320 +/- 67 vs. 244 +/- 55 min，P < 0.005）。LLR组的失血量显著较低（18.7 +/- 44.2 vs. 199.2 +/- 185.4 mL，P < 0.005）。两组的发病率相似（LLR组18.7%，OLR组35.7%）。LLR组中的一名供体发生胆漏，通过再次腹腔镜手术治疗。无论是否使用腹腔镜，移植物的解剖结构相似。住院时间和使用自注吗啡泵是没有不同的2 groups.Conclusion：左外侧部分收获腹腔镜是一种安全和可重复的程序，允许获得类似的移植物相比，剖腹手术，因此可以推荐给移植中心，有以前的经验，腹腔镜肝切除术。
Background Data and Objective: Left lateral sectionectomy for liver transplantation in children performed through laparoscopy is an innovative procedure that was developed by considering our acquired experience in both laparoscopic liver resection and graft harvesting in living donors. The main goal was to minimize donor morbidity while preserving the abdominal wall. Herein, we report the technical feasibility and reproducibility, and compared it with open liver resection (OLR).Methods: Sixteen successive donors underwent a laparoscopic liver resection (LLR) from 2001 to 2005. They were compared with 14 other donors who underwent a standard open liver resection (OLR) during a first period (1998-2004). First, this report describes the technical features of laparoscopic resection. Second, perioperative morbidity and graft characteristics were compared according to the use or not of the laparoscopic approach.Results: Laparoscopic harvesting was successfully performed in 15 of 16 cases in an intention-to-treat basis. One conversion was required to ensure the quality of the laparoscopic repair of a left portal vein injury occurring during the pedicle dissection. No specific complication related to laparoscopy was observed. As compared with OLR, the operation was longer (320 +/- 67 vs. 244 +/- 55 minutes, P < 0.005). The blood loss was significantly lower in the LLR group (18.7 +/- 44.2 vs. 199.2 +/- 185.4 mL, P < 0.005). The morbidity rate was similar in both groups (18.7% in LLR vs. 35.7% in OLR). One donor in the LLR group experienced a bile leak treated by redo laparoscopy. Grafts were anatomically similar irrespective of the use of laparoscopy. The duration of hospital stay and use of self-infused morphine pump was not different between the 2 groups.Conclusion: Left lateral section harvesting by laparoscopy is a safe and reproducible procedure, allowing to obtain similar grafts as compared with laparotomy and can therefore be recommended to transplant centers that have previous experience in laparoscopic liver resection.