Laparoscopic-assisted liver transplantation: A realistic perspective

Abstract

Laparoscopic approach was rarely described in recipients for liver transplantation (LT). We report the feasibility and safety of laparoscopic‐assisted LT (LA‐LT) in patients with unresectable liver metastases of neuroendocrine tumors. Total hepatectomy was performed laparoscopically with graft implantation through an upper midline incision. Liver grafts were retrieved from deceased donors. From July 2019 to July 2021, six patients (4 women, 2 men) underwent LA‐LT. Median age and BMI were 46 (29–54) and 24 (19–35) kg/m2, respectively. Implanted grafts were reduced (n = 3), full (n = 2), and a right split liver (n = 1). Median surgical time was 405 min (390–450) and median blood loss was 425 ml (250–600). Median cold and warm ischemia times were 438 min (360–575) and 35 min (30–40), respectively. Median anhepatic phase was 51 min (40–67) and midline incision was 14 cm (13–20) long. On postoperative day 5, median prothrombin index and serum bilirubin levels were 95% (70–117) and 11 (10–37) μmol/L, respectively. No Clavien‐Dindo > III complications were encountered. Median hospital stay was 12 days (10–14). After a median follow‐up of 8 (8–32) months, all patients were alive without tumor recurrence or adverse event. This preliminary series suggests that in selected patients, LA‐LT is a safe and effective option.

Minimizing Incision in Living Donor Liver Transplantation: Initial Experience and Comparative Analysis of Upper Midline Incision in 115 Recipients

“…We opted for the pure open upper midline incision approach for liver surgery over the totally minimally invasive [ 8 ] or laparoscopically assisted midline approaches [ 3 , 4 , 9 ] for several reasons. First, the complete laparoscopic or robotic approach is not suitable for many recipients due to their range of conditions, portal hypertension, technical difficulties in vascular and biliary anastomoses, and graft anatomical variations encountered.…”

Which incision is better for Lewis to Brown Norway rat liver transplantation, transverse or midline?

“…Clinically, incisional complications are not rare after OLT [ 18 ]. Of note, the midline incision has already been applied to perform human LT with larparoscopic assistance in many centers [ 19 ].…”

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

“…Even though MIS techniques are widely used in Hepato-pancreato-biliary (HPB) surgery the last several years, their application in liver transplant recipient surgery is minimized to 25 reported patients, with 8 of them requiring conversion to open surgery [15,[65][66][67][68]. Eguchi et al were the first to describe the possible applications of MIS in LT recipient surgery [69].…”

“…After the total hepatectomy, the next step in the LT is the graft implantation. The MIS approach for graft implantation includes open surgery though an upper midline incision, laparoscopic surgery or even robotic assisted surgery purely or in combination with other techniques [65][66][67][68][69]75]. In the laparoscopic and robotic assisted surgeries, a gel port was frequently placed in the incision of the previous liver extraction, that could be used as a hand port in case of an emergency [66][67][68][69][70].…”