title: Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept.
abstract: Adult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end-stage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 ± 56 mL/min/100 g, 13 ± 1.4 mm/Hg and 109 ± 19 mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.
authors.affiliation: Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium.
authors.forename: R I
authors.initials: RI
authors.lastname: Troisi
authors.forename: M
authors.initials: M
authors.lastname: Wojcicki
authors.forename: F
authors.initials: F
authors.lastname: Tomassini
authors.forename: P
authors.initials: P
authors.lastname: Houtmeyers
authors.forename: A
authors.initials: A
authors.lastname: Vanlander
authors.forename: F
authors.initials: F
authors.lastname: Berrevoet
authors.forename: P
authors.initials: P
authors.lastname: Smeets
authors.forename: H
authors.initials: H
authors.lastname: Van Vlierberghe
authors.forename: X
authors.initials: X
authors.lastname: Rogiers
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D020858:Tissue and Organ Harvesting
keywords: Laparoscopic liver donor hepatectomy; living donor liver transplantation; portal vein pressure; small-for-size grafts; transit time flow measurement