Laparoscopic Donor Hepatectomy for Living Related Transplantation

The most exciting innovation in living-donor liver transplant surgery is the living-liver donor hepatectomy. The introduction of laparoscopy to living-related renal transplantation has tremendously increased the incentive to donate while maintaining excellent donor and recipient outcomes. It is foreseeable that a similar effect may be brought by the systematic utilization of laparoscopic surgery in the living donor hepatectomy.

The benefit of decreasing postoperative pain by replacing the large subcostal incision now utilized with a smaller lower abdominal incision is evident. On the other hand, many technical aspects must be solved before a routine application of laparoscopy will be possible.

At the present time only left lateral hepatectomy including segments 2 and 3 has been performed by laparoscopy [32- 36].

The operation described is based on a hand-assisted laparoscopic approach through a suprapubic incision and five trocars. Carbon dioxide is used for pneumoperitoneum, and the transection of the liver parenchyma is performed with the ultrasonic dissector and the harmonic scalpel. Hemostasis is obtained by bipolar electrocoagulation, and a vascular stapler is used for the control of the larger vessels. At the time of the writing of this chapter, there is no official report of a laparoscopic right or left hepatectomy for donation to an adult patient. Due to the great interest of the industry in creating new and safer technology for lapa-roscopic surgery and the to the growing confidence of many surgeons in laparoscopic liver resection, it is possible that in the next decade laparoscopic donor hepa-tectomy will be performed as routinely as laparoscopic donor nephrectomies.

0 0

Post a comment