LAPAROSCOPIC LEFT LIVER SECTIONECTOMY (LLLS) FOR PEDIATRIC LIVING RELATED LIVER TRANSPLANTATION (LRLT).

PURPOSE: LRLT in children is a method to provide organs for transplantation. We report 2 cases of LLLS for pediatric LRLT. METHOD: Donor position: lithotomy with surgeon in French position. Trocars: three 12 mm, placed 2 cm upper the supra-umbilical mid-line and sub-costal bi-lateral on the nipple lines; one 5 mm in epigastrium. Special instrumentation: harmonic scissor, ligasure®, Hem-O-Lock clips, and Endo Catch-II® bag. Main steps: division of round, falciform, left triangular ligaments and of lesser omentum; inspection of anatomy; hepatic hilum dissection with exposure of the left hepatic artery; dissection of the right side of the falciform ligament with exposure of the left branch of the portal vein; dissection of the Arantius’ ligament and exposure of the left hepatic vein; parenchymal dissection with hilar plate and left biliary duct(s) section; Pfannestiel incision; placement of the graft (S2-3) into an Endo Catch-II® bag; vessels transection with endoTA; graft extraction. RESULTS: Case 1. Donor: 19 year-old woman (w=67 kg, h=165 cm). Operation time was 495 min; total ischemia time (TIT) 38 min, and warm ischemia time (WIT) 7 min. No blood loss. Postop course uneventful: after 3 months donor remains asymptomatic with normal liver function. Recipient:10-month-old girl affected by sclerosing cholangitis, (PELD=23); after 3 months of follow-up the recipient is well with normal liver function. Case 2. Donor: 25 year-old woman (w=53 kg, h=150 cm). Operation time was 405 min, TIT 43 min, and WIT 6 min. No blood loss; Postop course and follow up uneventful. Recipient: 11-month-old girl affected by biliary atresia (PELD=10); after a 1 month of follow-up she’s alive and well with normal liver function. CONCLUSION: No donor’s morbidity or mortality was observed. The laparoscopic pediatric LDLT is a safe and feasible procedure that should be considered in experienced centers with advanced laparoscopic expertise.