title: Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision.
abstract: BACKGROUND
  A living donor (LD) for liver transplantation (LT) is the best target for minimally invasive surgery. Laparoscope-assisted surgery (LAS) for LDs has gradually evolved. A donor safety rate of 100% should be guaranteed.
  
  
  METHODS
  We began performing LAS for LDs in June 2012. The aim of this report is to describe the surgical procedures of LAS in detail, discuss various tips and pitfalls, and address the potential for a smooth transition to more advanced LAS.
  
  
  RESULTS
  Preoperative planning based on three-dimensional image analysis is a powerful tool for successful surgery. The combination of liver retraction/countertraction and the pressure produced by pneumoperitoneum widens the dissectible/cuttable layer, increasing the safety of LAS. A flexible laparoscope provides excellent magnified vision in both the horizontal view along the inferior vena cava, under adequate liver retraction, and in the lateral view, to harvest left-sided grafts in critical procedures. Intentional omission of painful incisions is beneficial for LDs. Hepatectomy using a smaller midline incision is safe if a hanging maneuver is used. Safe transition from LAS to a hybrid technique involving a combination of pure laparoscopic surgery and subsequent open surgery seems possible.
  
  
  CONCLUSIONS
  LDLT surgeons have a very broad intellectual and technical frontier.
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
keywords: Laparoscopic hepatectomy; donor; donor surgery; laparoscopic surgery; laparoscopy