title: Standardized less invasive living donor hemihepatectomy using the hybrid method through a short upper midline incision.
abstract: BACKGROUND
  Recently, applications of less invasive liver surgery in living donor hepatectomy (LDH) have been reported. The objective of this study was to evaluate the safety and efficacy of a hybrid method with a midline incision for LDH.
  
  
  METHODS
  Hemihepatectomy using the hybrid method was performed in the fifteen most recent among 150 living donors who underwent surgery between 1997 and August 2011. Six donors underwent right hemihepatectomy and 9 underwent left hemihepatectomy. An 8-cm subxiphoid midline incision was created for hand assistance during liver mobilization and graft extraction. After sufficient mobilization of the liver, the hand-assist/extraction incision was extended to 12 cm for the right hemihepatectomy and 10 cm for a left hemihepatectomy. Encircling the hepatic veins and hilar dissection were performed under direct vision. Parenchymal transection was performed with the liver hanging maneuver. Bile duct division was performed after visualizing the planned transection point by encircling the bile duct using a radiopaque marker filament under real-time C-arm cholangiography.
  
  
  RESULTS
  All procedures were completed without any extra subcostal incision. All grafts were safely extracted through the 10-12-cm upper midline incision without mechanical injury. No donors required an allogeneic transfusion; all of them have returned to their preoperative activity levels.
  
  
  CONCLUSIONS
  LDH by the hybrid method with a short upper midline incision is a safe procedure.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Soyama
authors.forename: M
authors.initials: M
authors.lastname: Takatsuki
authors.forename: M
authors.initials: M
authors.lastname: Hidaka
authors.forename: I
authors.initials: I
authors.lastname: Muraoka
authors.forename: T
authors.initials: T
authors.lastname: Tanaka
authors.forename: I
authors.initials: I
authors.lastname: Yamaguchi
authors.forename: A
authors.initials: A
authors.lastname: Kinoshita
authors.forename: T
authors.initials: T
authors.lastname: Hara
authors.forename: S
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D001652:Bile Ducts / Q000601:surgery; D002758:Cholangiography; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D020127:Recovery of Function; D016896:Treatment Outcome