A 7-cm upper midline incision for living donor left lateral hepatectomy: singe-center consecutive 70 donor experience.
A 7-cm upper midline incision for living donor left lateral hepatectomy: singe-center consecutive 70 donor experience.
复制标题
活体左外侧肝切除术的 7 厘米上中线切口：单中心连续 70 例供体经验。
DOI：
10.1097/tp.0b013e31824b81fb
复制
发表时间：
2012
期刊：
影响因子：
6.2
通讯作者：
A. Nakazawa
中科院分区：
文献类型：
--
作者：
M. Kasahara;S. Sakamoto;T. Shigeta;H. Kanazawa;Chiaki Karaki;T. Kakiuchi;A. Fukuda;Hideaki Tanaka;N. Mastuno;A. Nakazawa
Experience of and technical improvements in living donor operation have led to the generalization of pediatric living donor liver transplantation (LDLT) with excellent patient survival and donor safety (1, 2). To reduce surgical invasion of the living donor, we started a program using a 7-cm upper midline I-shaped incision without laparoscopic assistance in 70 consecutive living donor left lateral segmentectomy to mitigate accumulating problems in the living donors (3). During the period from October 2005 to September 2011, 176 LDLTs were performed at the National Center for Child Health and Development, Tokyo, Japan. Abdominal drainage tube was not inserted in entire series. There were 19 hyper-reduced left lateral segmentectomy, 136 left lateral segmentectomy, 11 left lobectomy, 4 left with caudate lobectomy, and 6 right lobectomy among 176 LDLT donors. A 7-cm upper midline incision for left lateral segmentectomy was initiated from August 2008 regardless of the potential donor physical factors, and we have since carried out 70 left lateral segment LDLTs using previously reported surgical technique (2). A 7 cm of midline incision was made from the end of xiphoid process for better exposure, and Alexis wound protector (Applied Medical Resources Co., CA) and Kent retractor (Takasago Medical Industry Co., Tokyo, Japan) provide satisfactory view with traction of the falciform ligament (4). After isolation of the donor left hepatic artery, hepatic duct, and portal branch, hepatic parenchyma of the medial segment was transected 5 mm to the right side of the falciform ligament without blood inflow occlusion or graft manipulation. Intraoperative cholangiography is then performed by means of a catheter placed in the cystic duct. C-arm fluoroscopy is adapted during the procedure to enable us to check the optimal cutting point of the bile duct for all donors to prevent biliary complication (5). The skin was closed with subepidermal suture. Among 70 donors with upper midline I-shaped incision, the donor age was 33.4 7.0 years and body mass index was 20.7 2.3 kg/m. Duration of the donor operation was 216.9 223.3 minutes and blood loss was 216.9 222.3 g. The hospital stay was 8.86 1.38 days. None of the donors showed complications during the follow-up period and returned to their previous life. In comparison to 66 left lateral segment donors with conventional reverse T-shaped incision, there was no difference in the donor perioperative parameter, postoperative data, and recipient survival. Four donors had complications related to donor surgery: wound hernia in two, wound infection in one, and deep vein thrombosis in one. Duration of the donor operation was significantly longer in reverse T-shaped incision group, probably due to the learning curve of our team. There were trend toward low complication rate in I-shaped incision group. The hospital stay was significantly shorter in upper midline I-shaped incision group (Table 1). The current successful results of pediatric LDLT have established this technique in the treatment of end-stage liver disease. These techniques have expanded the potential donor pool and decreased the waiting list mortality in pediatric liver transplantation. However, donor risk had been reported with morbidity rate of 16%, and infections were the most commonly reported donor morbidities, given that donor safety should still be paramount over surgical cosmetics and surgeon preference (6). Although the procedure should be performed by experienced hepatobiliary and transplant team, our present experience demonstrated that living donation with 7-cm upper midline incision with cautious operation procedure may not be harmful for donors and recipients
影响因子：
9
作者：
TANAKA, K;UEMOTO, S;OZAWA, K
通讯作者：
OZAWA, K