A new technique of lateral approach for laparoscopy-assisted donor left hepatectomy

This report describes laparoscopy-assisted donor left hepatectomy preserving the caudate lobe (LADLH), and a new technique for hand-assisted liver transection between the left lobe and the caudate lobe beforehand, called the 'lateral approach.' Four donor patients underwent LADLH. Preoperative computed tomography investigated the depth and width between the left lobe and the caudate lobe from the Arantius duct. LADLH was performed through a 9cm midline epigastric hand-port incision with four ports. The confluence of the middle and left hepatic veins was encircled with tape. Hand-assisted liver transection between the left lobe and the caudate lobe was performed using laparosonic coagulating shears after precoagulation with radio frequency ablation under ultrasonographic guidance. Through the hand-port incision, the tape around the middle and left hepatic veins could be passed between the left lobe and the caudate lobe to the porta hepatis. We used the tape toward the end of the parenchymal transection to bring the transection plane closer to the surface. The liver parenchyma was divided at Cantlie's line under direct vision. The graft was extracted through the hand-port incision. All donors underwent LADLH completely without any intraoperative complication. None of the donors required transfusion or re-operation.