Robotic monosegment donor hepatectomy for pediatric liver transplantation: First report.
graft reduction
pediatric liver transplantation
robotic donor hepatectomy
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
revised:
19
07
2021
received:
06
05
2021
accepted:
27
07
2021
pubmed:
13
8
2021
medline:
3
3
2022
entrez:
12
8
2021
Statut:
ppublish
Résumé
LT for infants less than 5 kg remains a challenge with high technical complication rates, which is further compounded by large-for-size grafts requiring hyper-reduction. The benefits of MIDH especially for standard left lateral segment (LLS) resection have been unequivocally demonstrated. However, given the fine margins of error, the highly challenging technical aspects of anatomical graft reduction test the limits of safety and may not be routinely feasible with the conventional laparoscopic approach. A 14-month-old girl weighing 4.4 kg with extrahepatic biliary atresia was referred to our unit for an LT. Her mother volunteered to donate and the calculated volume of the LLS was 342 ml, with an estimated GRWR of 7.6. Given the extremely high GRWR, a segment II monosegment graft was planned. A RMDH was performed, with a final GRWR of 4. The donor and recipient were discharged on the 5th and 12th post-operative days, respectively. We present the first-ever report of an RMDH. Our report highlights the fact that robotic surgery can safely replicate a highly precise surgical operation, thereby safely pushing the limits of MIDH.
Sections du résumé
BACKGROUND
BACKGROUND
LT for infants less than 5 kg remains a challenge with high technical complication rates, which is further compounded by large-for-size grafts requiring hyper-reduction. The benefits of MIDH especially for standard left lateral segment (LLS) resection have been unequivocally demonstrated. However, given the fine margins of error, the highly challenging technical aspects of anatomical graft reduction test the limits of safety and may not be routinely feasible with the conventional laparoscopic approach.
CASE REPORT
METHODS
A 14-month-old girl weighing 4.4 kg with extrahepatic biliary atresia was referred to our unit for an LT. Her mother volunteered to donate and the calculated volume of the LLS was 342 ml, with an estimated GRWR of 7.6. Given the extremely high GRWR, a segment II monosegment graft was planned. A RMDH was performed, with a final GRWR of 4. The donor and recipient were discharged on the 5th and 12th post-operative days, respectively.
CONCLUSION
CONCLUSIONS
We present the first-ever report of an RMDH. Our report highlights the fact that robotic surgery can safely replicate a highly precise surgical operation, thereby safely pushing the limits of MIDH.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14110Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Rammohan A, Gunasekaran V, Reddy MS, et al. Graft reduction in pediatric liver transplantation: the myth of 4? Am J Transplant. 2018;18:3081-3082.
Kitajima T, Sakamoto S, Sasaki K, et al. Impact of graft thickness reduction of left lateral segment on outcomes following pediatric living donor liver transplantation. Am J Transplant. 2018;18:2208-2219.
Ogawa K, Kasahara M, Sakamoto S, et al. Living donor liver transplantation with reduced monosegments for neonates and small infants. Transplantation. 2007;83:1337-1340.
Han H-S, Cho JY, Kaneko H, et al. Expert panel statement on laparoscopic living donor hepatectomy. Dig Surg. 2018;35:284-288.
Cherqui D, Ciria R, Kwon CHD, et al. Expert consensus guidelines on minimally invasive donor hepatectomy for living donor liver transplantation from innovation to implementation: a joint initiative from the international laparoscopic liver society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA). Ann Surg. 2021;273(1):96-108.
Rammohan A, Reddy MS, Narasimhan G, et al. Live liver donors: is right still right? World J Surg. 2020;44:2385-2393.
Enne M, Pacheco-Moreira L, Balbi E, et al. Liver transplantation with monosegments. Technical aspects and outcome: a meta-analysis. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2005;11:564-569.
Mentha G, Belli D, Berner M, et al. Monosegmental liver transplantation from an adult to an infant. Transplantation. 1996;62:1176-1178.
Srinivasan P, Vilca-Melendez H, Muiesan P, et al. Liver transplantation with monosegments. Surgery. 1999;126:10-12.
Kanazawa H, Sakamoto S, Fukuda A, et al. Living-donor liver transplantation with hyperreduced left lateral segment grafts: a single-center experience. Transplantation. 2013;95:750-754.
Sakamoto S, Kanazawa H, Shigeta T, et al. Technical considerations of living donor hepatectomy of segment 2 grafts for infants. Surgery. 2014;156:1232-1237.
Fasel JHD, Schenk A. Concepts for liver segment classification: neither old ones nor new ones, but a comprehensive one. J Clin Imaging Sci. 2013;3:48.
Marino MV, Podda M, Fernandez CC, et al. The application of indocyanine green-fluorescence imaging during robotic-assisted liver resection for malignant tumors: a single-arm feasibility cohort study. HPB (Oxford). 2020;22:422-431.
Hong SK, Suh K-S, Kim H-S, et al. Pediatric living donor liver transplantation using a monosegment procured by pure 3D laparoscopic left lateral sectionectomy and in situ reduction. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2018;22:1135-1136.