Open or Laparoscopic Living Donor Liver Hepatectomy: Still a Challenging Operati

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.12611/full

Open or Laparoscopic Living Donor Liver Hepatectomy: Still a Challenging Operation!
R. I. Troisi*
DOI: 10.1111/ajt.12611
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

To the Editor:

I would like to thank our colleagues because they allow us to clarify a very important concept [1]. Donor safety is indeed the major concern independent of laparoscopic or open approach. Even an open approach and the presence of anatomical variations can be a challenging procedure as we highlighted in our article. The development of laparoscopic liver surgery in general was not with the aim of esthetic result or less pain but with the aim of reducing the rate of complications.

We acknowledge (and also stress in the article) that this is still only a “proof of principle” and not a validated procedure [2]. It is reputed that donor safety remains “the priority,” but all dogmatic or exclusionary positions against the innovation will never help the progress. Therefore, it is absolutely mandatory that all complications (including fatalities) have been reported in a transparent and systematic way. The site of transection of the bile duct as well as maintaining the right plane of transection is an important issue that needs further development, certainly in donors with some vascular or biliary anatomical variation. With the aim to improve that vision we are actually validating the role of near infrared technology with indocyanine green fluorescent imaging system (Troisi RI, unpublished data). In the specific case of the described procedure, after the initial learning curve we think that the first warm ischemic time can be reduced around 3 min. Usually, there is no need for additional bench reconstructive procedures.

In conclusion, we believe that one of the most important disadvantages of this technique requiring outstanding skills is its difficult reproducibility and, probably, that will not be definitely a technique for everyone. However, with the ongoing exponential worldwide growth of the laparoscopic liver surgery such procedures will be presumably studied and performed in increasing numbers.

Only the future will prove if the laparoscopic approach holds the same promise as it does in open liver surgery.

R. I. Troisi*