Pure laparoscopic living donor liver transplantation: Dreams come true

Abstract

Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24-year-old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.

Laparoscopic-assisted liver transplantation: A realistic perspective

“…Under these conditions, the first pure laparoscopic living donor liver transplantation was recently performed. 22 In conclusion, LA-LT seems to be feasible and safe if performed by highly experienced surgical teams in selected recipients. This innovative technique is a major step in the field of HPB surgery and liver transplantation.…”

“…The prolonged cold and warm ischemia times, which may be needed for such time‐consuming laparoscopic vascular anastomoses, would be better tolerated in these excellent quality grafts with short cold ischemia. Under these conditions, the first pure laparoscopic living donor liver transplantation was recently performed 22 …”

Laparoscopic donor and recipient hepatectomy followed by robot-assisted liver graft implantation in living donor liver transplantation

“…Beginning with laparoscopic liver mobilization for the recipients, we performed laparoscopic explant hepatectomy followed by graft implantation using the upper midline 11 . We then expanded our trial to graft implantation by robotic/laparoscopic hybrid method, anastomosis of the hepatic and portal veins by laparoscopic surgery, and anastomosis of the hepatic artery and bile duct by robot‐assisted surgery 12 . Herein, we present our first experience of robot‐assisted liver graft implantation after a total laparoscopic explant hepatectomy in a living donor LT (LDLT).…”

Early experiences with developing techniques for pure laparoscopic explant hepatectomy in living donor liver transplantation

“…Through years of experience, [9] the LT team members have recently succeeded in performing pure laparoscopic explant hepatectomy and graft implantation in April 2021. [10] Subsequently, we have performed pure laparoscopic explant hepatectomy and hybrid laparoscopic/robotic graft implantation since June 2021. The other surgeon (K.-W.L.)…”