IngentaConnect Laparoscopic procurement model for living donor liver transplanta...

Authors: Pinto, Peter A¹; Montgomery, Robert A²; Ryan, Bradley¹; Roberts, William¹; Hsu, Thomas¹; Kavoussi, Parviz¹; Klein, Andrew S²; Kavoussi, Louis R¹; Molmenti, Ernesto P²

Source: Clinical Transplantation, Volume 17, Supplement 9, June 2003 , pp. 39-43(5)

Publisher: Blackwell Publishing

Abstract:

Pinto PA, Montgomery RA, Ryan B, Roberts W, Hsu T, Kavoussi P, Klein AS, Kavoussi LR, Molmenti EP. Laparoscopic procurement model for living donor liver transplantation.

Clin Transplant 2003: 17 (Suppl. 9): 39-43. © Blackwell Munksgaard, 2003 Abstract: Background/Aims:

Noting the contribution to renal transplantation by the introduction of the laparoscopic approach to donor nephrectomy, we investigated the possibility of performing a laparoscopic hepatic lobe procurement with the goal of performing a live donor liver transplantation. We describe our technique and determine its feasibility for such a goal. Methods:

The surgical technique was developed over a series of 12 adult female pigs and adapted in two human cadavers. The technique included pneumoperitoneum with CO₂, mobilization of the liver, and transection of the parenchyma into right and left lobes with a laparoscopic cavitron ultrasonic aspirator. The vascular inflow and outflow structures (hepatic artery, portal vein, hepatic veins) of the anatomical specimen being procured were preserved undisturbed during the hepatic transection. No temporary vascular occlusion techniques were utilized. The vascular structures were stapled and sectioned just prior to removal of the specimen. Results:

Hepatic lobectomies were successfully performed laparoscopically. Vascular and biliary structures were preserved to allow for subsequent transplantation. Operative time from establishment of pneumoperitoneum to lobe procurement was under 4 h. Conclusions:

This study demonstrates the feasibility of laparoscopic living donor procurement for liver transplantation, from both a technical and a physiological perspective.

Keywords: liver transplantation; laparoscopy; liver donors; liver resection; minimally invasive surgery

Document Type: Research article

DOI: 10.1034/j.1399-0012.17.s9.7.x

Affiliations: 1: Department of Surgery, 2: Division of Transplantation, and Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA

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