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Current Status of Surgical Incisions Used in Donors During Living Related Liver Transplantation—A Nationwide Survey in Japan

Shirabe, Ken, MD, PhD1,2; Eguchi, Susumu, MD, PhD3; Okajima, Hideaki, MD, PhD4; Hasegawa, Kiyoshi, MD, PhD5; Marubashi, Shigeru, MD, PhD6; Umeshita, Koji, MD, PhD7; Kawasaki, Seiji, MD, PhD8; Yanaga, Katsuhiko, MD, PhD9; Shimada, Mitsuo, MD, PhD10; Kaido, Toshimi, MD, PhD4; Kawagishi, Naoki, MD, PhD11; Taketomi, Akinobu, MD, PhD12; Mizuta, Koichi, MD, PhD13; Kokudo, Norihiro, MD, PhD5; Uemoto, Shinji, MD, PhD4; Maehara, Yoshihiko, MD, PhD2 Japanese Liver Transplantation Society

doi: 10.1097/TP.0000000000002126
Original Clinical Science—Liver

Background Smaller surgical incisions have recently been introduced in living donor liver procurement. This study used national data from Japan to clarify the present status of surgical incisions in living donor liver procurement.

Methods A nationwide, questionnaire-based survey related to 3121 donors and recipients was used. Donors were divided into 2 groups: left lateral segment graft (LLSG) procurement (n = 690) and other types (n = 2431). Incisions were classified into 6 types: type I, upper midline and bilateral subcostal; type II, upper midline and right subcostal; type III, upper midline and right subcostal to the right lateral margin of the abdominal rectus muscle; type IV, upper midline without laparoscopy; type V, upper midline with laparoscopy; and type VI, lower abdominal using the full laparoscopic technique. Types I, II, and III were regarded as standard, and types IV, V, and VI as small incisions.

Results In LLSGs, blood transfusion and postoperative complication rates were significantly less frequent in the small incision group than in the standard group. In other graft types, there were no significant differences in blood transfusion, postoperative complication, and recipients’ graft loss rates. The rates of wound extension during surgery were 2.8% and 2.1% in the small incision group in LLSGs and in other graft types, respectively. A small incision was adapted more frequently and postoperative complications were less common in high-volume centers.

Conclusions Various incisions have been adopted in living donor liver procurement. Donor safety and graft integrity appear to have been retained for donors receiving small incisions.

National survey data from Japan support the movement toward smaller incisions in live donor liver transplantation without compromise of donor safety.

1 Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Maebashi, Japan.

2 Department of Surgery and Science, Kyushu University, Fukuoka, Japan.

3 Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

4 Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

5 Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

6 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University.

7 Department of Surgery, Osaka University, Osaka, Japan.

8 Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.

9 Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.

10 Department of Surgery, Tokushima University, Tokushima, Japan.

11 The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.

12 Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

13 Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Japan.

Received 4 July 2017. Revision received 26 December 2017.

Accepted 2 January 2018.

The authors declare no funding or conflicts of interest.

K.S. participated in research design, writing of the article, performance of the research, contributed new reagents or analytic tools, and participated in the data analysis. S.E. participated in research design, writing of the article, performance of the research, and data analysis. H.O. participated in research design, writing of the article, and performance of the research. K.H. participated in research design, writing of the article, and data analysis. S.M. participated in research design, writing of the article, performance of the research, and data analysis. K.U. participated in research design and writing of the article. S.K. participated in research design. K.Y. participated in research design. M.S. participated in research design and writing of the article. T.K. participated in research design and writing of the article. N.K. participated in research design. A.T. participated in research design and data analysis. K.M. participated in research design. N.K. participated in research design and writing of the article. S.U. participated in research design and writing of the article. Y.M. participated in research design and writing of the article.

Correspondence: Ken Shirabe, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, Gunma University, 3-39-22 Showa Machi, Maebashi, Gunma 371-8511, Japan. (kshirabe@gunma-u.ac.jp).

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