Korean J Transplant.  2020 Dec;34(Supple 1):S18. 10.4285/ATW2020.OP-1078.

Single center experience of hepatic artery reconstruction during living donor liver transplantation: microscope versus surgical loupe

• Seo C

• KMID: 2509138
• DOI: http://doi.org/10.4285/ATW2020.OP-1078

Abstract

Background
Hepatic artery (HA) reconstruction during living donor liver transplantation (LDLT) is the key step due to the small diameter of the artery and risk of HA thrombosis (HAT). To overcome this risky procedure, it has been preferred to using microscope during HA reconstruction by experienced microsurgeon. However, it takes long time to complete the procedure and has long and steep learning curve. To make this procedure simple, some transplant surgeons recently try the procedure using surgical loupe. We conduct this study to compare the outcomes after HA reconstruction using conventional microscope versus surgical loupe.
Methods
We retrospectively reviewed outcomes of 300 LDLTs at Seoul St. Mary’s Hospital from April 2014 to July 2020. From April 2014 to September 2017 (era 1), HA reconstruction was performed with conventional microscope by an experienced plastic surgeon. From September 2017 to end date (era 2), it was performed with surgical loupe (×5.0) by an experienced transplantation surgeon.
Results
There was no difference in most perioperative outcomes between two groups including major postoperative complications: HAT (2/150 vs. 1/150, P=0.562), postoperative bleeding (13/150 vs. 6/150, P=0.097), and biliary leak (18/150 vs. 13/150, P=0.343). It was statistically significant between two groups for total operation time (436.66±83.91 minutes vs. 415.35±68.55 minutes, P=0.035). Multivariable regression modeling to adjust for baseline differences showed that the use of surgical loupe was not associated with HA thrombosis.
Conclusions
HA reconstruction with surgical loupe makes results as good as with microscope for the transplant surgeon and contributes to reducing operating time.