生体肝移植における腹腔鏡補助下ドナー肝切除―葉切除の理論と手技―

Laparo-assisted living donor hemihepatectomy : Its rationale and surgical technique

◆要旨：腹腔鏡を用いた肝腫瘍切除は近年飛躍的に発展しているが，生体肝移植におけるドナー肝切除に対する応用は少ない．ドナー肝切除の特殊性が1つの要因であるが，術後の愁訴を軽減するために今後検討されるべき術式と思われる．右葉/左葉グラフト採取においては現時点では小開腹を用いた腹腔鏡補助下肝切除が安全と思われる．ここで提示する術式は12cmの上腹部小開腹創と腹壁吊上げ法を用いて行われ，技術的には肝右葉脱転による左旋回，hanging maneuverのtaping techniqueおよび胆管切離断端の処理が3つの大きなポイントである．本稿では本術式の手技的な側面，注意すべき点などについて筆者らの見解を述べた．

　Recently, laparoscopic hepatectomy for liver tumors has progressed rapidly and widely, but there are few reports of practical applications of laparoscopic procedures to donor-hepatectomy in LRLT. The technical difficulty in the deep parenchymal dissection keeping both the inflow and outflow of the vessels appears to prevent its popularization. The laparoscopic hepatectomy is thought to be a promising surgical technique for improving donor's QOL after hepatic donation. From the viewpoints of approach, the hand-assisted procedure using a mini-laparotomy is safe and useful in adult-to-adult LRLT that needs right or left hemihepatectomy.

　An abdominal-wall lifting method was mainly used for the procedure, with several access ports and a 12-cm upper-abdominal laparotomy. Practically, 1）the mobilization and left rotation of the liver, 2）Belghiti's taping technique for hanging maneuver and 3）closure of the hepatic duct by 6-0 running suture were three important points. The advantage of the taping technique seems to be the usage of the tape as a guide for the direction of the hepatic parenchymal dissection. In this article, we described the technical aspect of laparo-assisted donor hemihepatectomy for adult-to-adult LRLT.