Laparoscopic Left Lateral Monosegmentectomy in Pediatric Living Donor Liver Transplantation Using Real-Time ICG...

Nowadays, laparoscopic left lateral sectionectomy has been acknowledged as a standard practice in pediatric living donor liver transplantation (PLDLT).^{1, 2} We here report the first case of laparoscopic left lateral monosegmentectomy (L-LLM) in PLDLT using real-time ICG fluorescence in situ reduction in China.

A 35-year-old father volunteered for living donation to his daughter who diagnosed with liver cirrhosis and portal hypertension after Kasai operation due to biliary atresia. Preoperative liver function was normal. Liver dynamic CT showed a left lateral graft volume of 387.5cm³ with a graft to recipient weight ratio (GRWR) of 4.45%. Ratio of the maximum thickness of the left lateral segment to the anteroposterior diameter of the recipient's abdominal cavity was 1.09. The estimated segment II volume was 245.3cm³ and GRWR was 2.82%. L-LLM was scheduled.³ No anatomic variation was seen.

The transection was divided into two stages. Stage I: Separating the left lateral section along the right side of sickle ligament. Stage II: Anatomic in situ reduction of segment III by using real-time ICG fluorescence. The left bile duct was transected above the bifurcation by ICG fluorescence cholangiography. The total operation time was 200 min without transfusion. The final graft weight was 225.2 g with GRWR of 2.59%. The donor was discharged uneventfully on postoperative day 4, while the graft function recovered to normal in recipient without any graft-related complication.

L-LLM with in situ reduction is feasible in PLDLT by using real-time ICG fluorescence in experienced transplant center.