Korean J Transplant.  2023 Nov;37(Suppl 1):S16. 10.4285/ATW2023.F-5812.

Various Retracting techniques for the laparoscopic living donor hepatectomy: double rubber extraction to facilitate liver resection

• Chong EH
• Kim KH
• Kang I
• Lee SH
• Yang SJ

• KMID: 2551590
• DOI: http://doi.org/10.4285/ATW2023.F-5812

Abstract

Background
Laparoscopic liver resection is now performed worldwide as the technical development and experiences has been accumulated in the recent decade. Especially, laparoscopic living donor hepatectomy (LLDH) has been on the rise with its advantages of lesser blood loss, lesser postoperative morbidity, shorter hospital stays and better cosmetic outcomes compared to open surgery. But, surgeons still face technical difficulties on details of operation field exposure. This study aimed to introduce various retraction techniques including double rubber band retraction which can efficiently expose the surgical plane in LLDH, and show the perioperative outcomes.
Methods
The data was collected retrospectively and the perioperative outcomes were analyzed. All patients underwent LLDH from September 2021 to March 2023. We applied various retraction methods, such as, round loop retraction of cystic duct to expose the hilum, internal retraction using vessel loops and metal clips for vessel isolation, and double rubber band retraction to expose the parenchymal resection plane during liver resection.
Results
Nine of six male and three female patients was included. The mean age was 39 years (range, 25–57 years). The median intraoperative bleeding was 300 mL (range, 130–1100 mL). The median operation time was 430 minutes (range, 375–555 minutes). There were only three patients (33.3%) with minor postoperative complications and no major complication. And the mean postoperative hospital stay was 7.0 days (1–6 days).
Conclusions
Liver tractions using one elastic rubber band was usefully performed. However, when approaching closer to the dome of the liver, one elastic band may not be sufficient to expose the liver parenchyma. By using a double rubber band technique, it solved the insufficient traction of the upper area and also replaced the hanging maneuver. Also combinations of already introduced retraction methods, we can ensure the safety of the donor and also procure an appropriate graft from living donors.