title: Elective living donor liver transplantation by hybrid hand-assisted laparoscopic surgery and short upper midline laparotomy.
abstract: BACKGROUND
  Although the technique of liver transplantation is well developed, the invasiveness of the operation can be decreased with laparoscopic procedures.
  
  
  METHODS
  We performed elective living donor liver transplantation (LDLT) through a short midline incision combined with hand-assisted laparoscopic surgery (HALS). Nine selected patients with end stage liver disease underwent the procedure between July, 2010 and February, 2011 (median age 60, median Child-Pugh 9, median MELD score 14). Splenectomy was performed simultaneously in 7 cases. The liver (and spleen) were mobilized by a sealing device under a HALS procedure with an 8-cm upper midline incision, followed by explantation of the diseased liver (and spleen) through the upper midline incision which was extended to 12 to 15 cm. Partial liver grafts were implanted through the upper midline incision.
  
  
  RESULTS
  The median duration of the operation was 741 minutes, the median time needed for anastomosis was 48 minutes, the median blood loss was 3,940 g, and the median liver weight was 866 g. Eight recipients are alive and have good graft function. A difficult implantation for one patient required an additional right transverse incision. When compared with 13 recent liver recipients who underwent LDLT with a regular Mercedes-Benz-type incision, no clinically relevant drawbacks of the HALS hybrid procedure were observed.
  
  
  CONCLUSIONS
  We have shown the feasibility and safety of LDLT performed through a short midline incision without abdominal muscle disruption with the aid of HALS.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. sueguchi@nagasaki-u.ac.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Soyama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Tomonaga
authors.forename: Izumi
authors.initials: I
authors.lastname: Muraoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013156:Splenectomy; D016896:Treatment Outcome