Current status of surgical incisions used in donors during living related liver transplantation – a nationwide survey in Japan

AbstractBackgroundSmaller 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.MethodsA nationwide, questionnaire-based survey related to 3121 donors and recipients was used. Donors were divided into two groups: left lateral segment graft (LLSG) procurement (n=690) and other types (n=2431). Incisions were classified into six 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.ResultsIn 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 adopted more frequently and postoperative complications were less common in high-volume centers.ConclusionsVarious incisions have been adopted in living donor liver procurement. Donor safety and graft integrity appear to have been retained for donors receiving small incisions. 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 two groups: left lateral segment graft (LLSG) procurement (n=690) and other types (n=2431). Incisions were classified into six 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 adopted 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. Correspondence: Ken Shirabe, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, Gunma University, 3-39-22 Showa Machi, Maebashi, Gunma 371-8511, Japan. E-mail: kshirabe@gunma-u.ac.jp Authorship Ken Shirabe • Participated in research design • Participated in the writing of the paper • Participated in the performance of the research • Contributed new reagents or analytic tools • Participated in data analysis Susumu Eguchi • Participated in research design • Participated in the writing of the paper • Participated in the performance of the research • Participated in data analysis Hideaki Okajima • Participated in research design • Participated in the writing of the paper • Participated in the performance of the research Kiyoshi Hasegawa • Participated in research design • Participated in the writing of the paper • Participated in data analysis Shigeru Marubashi • Participated in research design • Participated in the writing of the paper • Participated in the performance of the research • Participated in data analysis Koji Umeshita • Participated in research design • Participated in the writing of the paper Seiji Kawasaki • Participated in research design Katsuhiko Yanaga • Participated in research design Mitsuo Shimada • Participated in research design • Participated in the writing of the paper Toshimi Kaido • Participated in research design • Participated in the writing of the paper Naoki Kawagishi • Participated in research design Akinobu Taketomi • Participated in research design • Participated in data analysis Koichi Mizuta • Participated in research design Norihiro Kokudo • Participated in research design • Participated in the writing of the paper Shinji Uemoto • Participated in research design • Participated in the writing of the paper Yoshihiko Maehara • Participated in research design • Participated in the writing of the paper Copyright © 2018 Wolters Kluwer Health, Inc. 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