Laparoscopic procurement model for living donor liver transplantation.
OBJECTIVE
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.
Pinto
Peter A
PA
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287-611, USA.
Montgomery
Robert A
RA
Ryan
Bradley
B
Roberts
William
W
Hsu
Thomas
T
Kavoussi
Parviz
P
Klein
Andrew S
AS
Kavoussi
Louis R
LR
Molmenti
Ernesto P
EP
D000818:Animals; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D023421:Models, Animal; D034421:Sus scrofa