title: Laparoscopy-assisted donor right hepatectomy using a hand port system preserving the middle hepatic vein branches.
abstract: BACKGROUND
  This report reviews our experience with a modified right hepatectomy (MRH) using laparoscopic or laparoscopy-assisted techniques preserving the middle hepatic vein (MHV) branches in living donor liver transplantation.
  
  
  METHODS
  Nine female donors (17-36 years) underwent a laparoscopic MRH under pneumoperitoneum (L-MRH; n = 2) or a laparoscopy-assisted MRH (LA-MRH; n = 7) with a hand port device. The donors for this minimally invasive surgery were volunteers with the willingness to undergo laparoscopic surgery and recipients who were not in urgent need of transplantation. Mobilization of the right liver was performed under pneumoperitoneum in all cases. Hilar dissection and parenchymal transection were performed under pneumoperitonuem (n = 2) or with a mini-laparotomy incision (n = 7) using an ultrasonic aspirator without the Pringle maneuver. The major MHV branches (>5 mm) were preserved using Hem-o-lock clips. The graft was extracted through the site of the hand port device or the mini-laparotomy. On the back table, the MHV branches were reconstructed with an artificial vascular graft.
  
  
  RESULTS
  There were no open conversions, and the graft was transplanted without any problem in every case. The operative time for the donors was 765 min and 898 min in the L-MRH patients, and it ranged from 310 to 575 min for the laparoscopy-assisted surgery. None of the donors required transfusion or reoperation; they were discharged on postoperative day 8-14 with normal liver function. A major complication occurred in one donor; fluid collection along the liver resection margin with fever was treated and resolved after percutaneous drainage.
  
  
  CONCLUSIONS
  A right hepatectomy preserving the MHV or its branches by minimally invasive techniques including total laparoscopic surgery was technically feasible. However, further refinements of the procedure are required prior to wide clinical application.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea. kssuh@plaza.snu.ac.kr
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Taehoon
authors.initials: T
authors.lastname: Kim
authors.forename: Joohyun
authors.initials: J
authors.lastname: Kim
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult