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Updated: Jul 13, 2026
Single Port Donor Nephrectomy
Published on: March 12, 2011
Midline Incision Living Donor Liver Transplantation as a Step Toward Minimally Invasive Liver Transplantation: A
A Rammohan1, K Palaniappan1, Y Puri1
1The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
Background:
Performing the living donor liver transplant (LDLT) recipient operation via a midline incision (MILT) may reduce perioperative morbidity and postoperative wound related issues. Also, it is likely to bear significance in the current era of minimally invasive recipient surgery (MIRS) as competence in performing an MILT is likely to be the stepping-stone toward and importantly, the safety net in performing a safe MIRS. We present our series of MILT, highlighting the evolution and its technical modifications.
Methods:
Propensity score matched analysis (based on MELD, GRWR, and etiology) of MILT versus standard LDLT (reverse L incision) (SILT) with a 1:2 ratio was performed from a prospectively collected database. All perioperative recipient data including postoperative morbidity and mortality were compared.
Results:
Among 75 MILT and 150 SILT patients, there were no significant differences between the groups with regards to operative time (520 ± 73 vs. 522 ± 120 min, p = 0.89) and cold ischemia time (110 ± 45 vs. 118 ± 60 min, p = 0.31). The warm ischemia time was significantly longer in the MILT group (52 ± 24 min vs. 46 ± 14 min, p = 0.02). While the mean blood loss was comparable between the groups (1675 ± 850 vs. 1550 ± 1150 mL, p = 0.41), blood transfusion requirements including packed red cells (5 (IQR:3-7) vs. 3 (IQR:1-6), p = 0.03) and fresh frozen plasma (3 (IQR:2-4) vs. 2 (IQR:0-3), p = 0.02) were significantly higher in MILT patients. There was no difference between the groups with regards to major 90-day morbidity (18.6% vs. 15.3%, p = 0.53), duration of hospital stay (15 (IQR:10-18) vs. 14 (IQR: 12-18) days, p = 0.06), and 1-year (92% vs. 95.3%) and 3-year mortality (92% vs. 91.4%) (p = 0.89).
Conclusion:
We present the feasibility and safety of MILT in LDLT. In the current milieu of MIRS, competence in performing a safe MILT may become an essential component of the recipient surgeon's armamentarium.
Insights
Midline incision liver transplant (MILT) is a feasible and safe approach for living donor liver transplant recipients. While it showed increased blood transfusion needs, MILT did not significantly impact major morbidity or long-term mortality compared to standard incisions.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Minimally Invasive Surgery
Background:
- Living donor liver transplant (LDLT) recipient surgery can be performed via midline incision (MILT).
- MILT may reduce perioperative morbidity and wound complications.
- MILT is considered a foundational skill for minimally invasive recipient surgery (MIRS).
Purpose of the Study:
- To evaluate the feasibility and safety of MILT in LDLT recipients.
- To compare perioperative outcomes of MILT versus standard liver transplant incisions (SILT).
- To highlight technical modifications and evolution of the MILT procedure.
Main Methods:
- Propensity score matched analysis of 75 MILT and 150 SILT patients.
- Comparison of operative time, ischemia times, blood loss, and transfusion requirements.
- Assessment of 90-day major morbidity, hospital stay, and long-term mortality.
Main Results:
- No significant differences in operative time or cold ischemia time between MILT and SILT.
- Significantly longer warm ischemia time in the MILT group (p=0.02).
- Higher blood transfusion requirements (packed red cells and fresh frozen plasma) in MILT patients (p=0.03 and p=0.02, respectively).
- No significant difference in 90-day major morbidity, hospital stay, or 1- and 3-year mortality.
Conclusions:
- MILT is a feasible and safe surgical approach for LDLT recipients.
- Proficiency in MILT is valuable for surgeons pursuing MIRS.
- MILT offers potential benefits in reducing wound-related issues and morbidity.
