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Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe
James V Guarrera1, Prashant Sinha, Steven J Lobritto
1Center for Liver Disease and Transplantation, New York Presbyterian Hospital and Columbia University College of Physicians and Surgeons, New York, NY, USA. jjg46@columbia.edu
Abstract:
Use of operative microscopy (OM) has dramatically reduced the incidence of hepatic artery thrombosis (HAT) in children undergoing segmental liver transplantation. We used OM (12-16x) in our early experience. We changed to high power loupe magnification (6x) after 14 cases. We examined our experience with microvascular hepatic artery reconstruction in 28 consecutive children (< 18 years) who underwent living donor (LDLT) or split liver transplantation (SLT). Reconstructions were done with interrupted, end-to-end anastomoses with 8-0 polypropylene using microvascular techniques. Group 1 consisted of 14 children who underwent LDLT employing OM for the hepatic artery anastomosis. Group 2 consisted of the subsequent 14 children (11 LDLT, 3 SLT) in whom 6x loupe optics were used for the arterial anastomosis. Grafts included 25 left lateral segments, 2 left lobes, and 1 right lobe. Recipients' median age was 1.0 years (range 3 months to 17 years). The mean follow-up time was 27.1 months. There were no cases of HAT. Variables of age, sex, graft type, number of Doppler ultrasound exams (DUS), and biliary complications were similar between groups. Microvascular hepatic artery reconstruction in children with 6x loupe magnification can yield results as good as operative microscopy.
Insights
High-power loupe magnification (6x) provides effective microvascular hepatic artery reconstruction in pediatric liver transplantation, achieving results comparable to operative microscopy. This technique avoids hepatic artery thrombosis in pediatric liver transplant recipients.
Area of Science:
- Pediatric Surgery
- Transplant Surgery
- Vascular Surgery
Background:
- Hepatic artery thrombosis (HAT) is a significant complication in pediatric liver transplantation.
- Operative microscopy (OM) has been used to reduce HAT incidence.
- A transition from OM to high-power loupe magnification occurred in this center's practice.
Purpose of the Study:
- To compare the efficacy of operative microscopy (OM) versus 6x loupe magnification for microvascular hepatic artery reconstruction in pediatric liver transplantation.
- To evaluate the incidence of hepatic artery thrombosis (HAT) in children undergoing liver transplantation with different magnification techniques.
Main Methods:
- A retrospective review of 28 consecutive pediatric liver transplant recipients (<18 years) was conducted.
- Group 1 (n=14) underwent reconstruction with OM (12-16x).
- Group 2 (n=14) underwent reconstruction with 6x loupe magnification.
Main Results:
- No cases of hepatic artery thrombosis (HAT) were observed in either group.
- Key variables including age, graft type, and biliary complications were similar between the groups.
- Microvascular hepatic artery reconstruction using 6x loupe magnification yielded comparable outcomes to OM.
Conclusions:
- Microvascular hepatic artery reconstruction in pediatric liver transplantation can be safely and effectively performed using 6x loupe magnification.
- 6x loupe magnification offers a viable alternative to operative microscopy for hepatic artery anastomosis in pediatric liver transplantation, with similar safety and efficacy.
- This finding supports the use of high-power loupe magnification in centers performing pediatric liver transplantation.
