Indocyanine green fluorescence image-guided total laparoscopic living donor right hepatectomy: The first case report from Mainland China

Autor: Mingyi Chen, Wei-dong Duan, Xiangfei Meng, Hongguang Wang, Yinzhe Xu, Shichun Lu
Rok vydání: 2018
Předmět:
Surgical margin
medicine.medical_specialty
Cirrhosis
genetic structures
GRWR
graft to recipient body weight ratio
BMI
body mass index
medicine.medical_treatment
ICG
indocyanine green
MHV
middle hepatic vein
SLV
standard liver volume
Hilum (biology)
030230 surgery
A2ALDLT
adult-to-adult living donor liver transplantation
Article
Fluorescence
MELD
model for end-stage liver disease
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
RHV
right hepatic vein
medicine
TLDRH
total laparoscopic living donor right hepatectomy
MRCP
magnetic resonance cholangiopancreatography
Laparoscopy
Right hepatectomy
medicine.diagnostic_test
Bile duct
business.industry
Living donor liver transplantation
IGFI
indocyanine green fluorescence image
medicine.disease
eye diseases
IOUS
intraoperative ultrasonography
POD
postoperative day
Indocyanine green
Surgery
Dissection
HBV
hepatitis B virus
medicine.anatomical_structure
chemistry
030211 gastroenterology & hepatology
Hepatectomy
business
CUSA
cavitron ultrasonic surgical aspirator
Zdroj: International Journal of Surgery Case Reports
ISSN: 2210-2612
DOI: 10.1016/j.ijscr.2018.11.033
Popis: Highlights • Total laparoscopic living donor right hepatectomy is rarely reported worldwide. • Right liver transection plane used to be determined through ischemic demarcation and IOUS. • The site of bile duct division was determined according to MRCP or intraoperative cholangiography. • ICG fluorescence can real-timely visualize the surgical margin and biliary branches of right lobe. • ICG fluorescence navigation makes the procedure simplified, safer and more accurate.
Introduction Total laparoscopic living donor right hepatectomy (TLDRH) is sporadically reported worldwide. Liver transection margin used to be determined by ischemic demarcation or intraoperative ultrasonography. To identify the site of bile duct division relied on preoperative MRCP and intraoperative cholangiography, which is experience demanding. Presentation of case A 34-year-old man volunteered for living donation to his brother who suffered decompensated HBV-related cirrhosis. Right lobe donation without MHV fulfilled the volumetric criteria. After hilum dissection, ICG was injected into the right portal branch. Right lobe was transected tracing the real-time fluorescence-enhanced borderline and the course of MHV. The right bile duct was transected above the bifurcation that was fluorescently visualized within the parenchyma. The liver graft was retrieved from a pre-made suprapubic incision after simple vascular clamping. The warm ischemia time was 6 min. The recipient procedure was successful with back-table graft venoplasty using cryopreserved iliac artery allografts. The donor recovered uneventfully and was discharged from hospital on POD 7. Discussion The operative time, blood loss and postoperative course of donor is comparable to those undergoing ordinary laparoscopic right hepatectomy in our institute. ICG fluorescence can real-timely visualize the surgical margin and biliary branches of right lobe, which helps preserve every last bit of functional liver volume for the donor and avoid the complicated traditional intraoperative cholangiography. Conclusion TLDRH proves to be achievable in surgical teams confortable with both laparoscopic hepatectomy and LDLT. ICG fluorescence navigation could make the procedure simplified, safer and more accurate. More practice and technical modification are necessary.
Databáze: OpenAIRE
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