Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Prima epatectomia laparoscopica per Trapianto di Fegato

Safi Dokmak (MD, PhD), chirurgo epatobiliopancreatico all’Ospedale Beaujon (Clichy), Università Paris VII, in Francia, pubblica la prima epatectomia totale per trapianto di fegato effettuata completamente per via laparoscopica.

L’intervento viene eseguito per metastasi multiple da carcinoma neuroendocrino.

Il successivo trapianto di fegato è stato eseguito attraverso una incisione mediana xifo-ombelicale.

La referenza bibliografica per questo evento è:

Safi Dokmak, François Cauchy, Ailton Sepulveda, Pierre Marie Choinier, Fédérica Dondéro, Béatrice Aussilhou, Camille Hego, Sophie Chopinet, Pauline Infantes, Emmanuel Weiss, Claire Francoz, Alain Sauvanet, Catherine Paugam-Burtz, François Durand, Olivier Soubrane: Laparoscopic Liver Transplantation: Dream or Reality? The First Step With Laparoscopic Explant Hepatectomy. In: Annals of surgery, vol. 272, no. 6, pp. 889 – 893, 2020, ISSN: 15281140, (Cited by: 10).

Abstract

OBJECTIVE: To introduce the laparoscopic approach in liver transplant recipients. SUMMARY OF BACKGROUND DATA: Despite the increasingly frequent use of laparoscopy in living donor hepatectomy, the laparoscopic approach has never been reported in liver transplant recipients. METHODS: A 52-year-old woman (body mass index: 18.5 kg/m) with neuroendocrine liver metastases of a digestive origin underwent hybrid liver transplantation by pure laparoscopic total hepatectomy and liver graft implantation using a preexisting midline incision. The hepatic pedicle vessels were dissected after division of the bile duct without a porto-caval shunt. Left lateral sectionectomy and early division of the common trunk allowed near completion of caval dissection with no prolonged inflow occlusion. The liver graft was reduced and latero-lateral caval anastomosis was performed. RESULTS: Surgery lasted 400 minutes with 400 mL of blood loss. The anhepatic phase lasted 43 minutes. Warm ischemia time and cold ischemia times were 38 and 466 minutes, respectively. The postoperative course was uneventful. CONCLUSIONS: This case study suggests that the hybrid approach may be feasible and safe in selected recipients. The decision to use this surgical approach should be made in transplant centers with significant expertise in both laparoscopic liver and pancreatic surgery. Further reducing the size of the abdominal incision is the next step, which may be achieved with the development of vascular anastomoses devices.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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