• 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, and Olivier Soubrane.
• Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris and University of Paris.
• Ann. Surg. 2020 Dec 1; 272 (6): 889-893.

ObjectiveTo introduce the laparoscopic approach in liver transplant recipients.Summary Of Background DataDespite the increasingly frequent use of laparoscopy in living donor hepatectomy, the laparoscopic approach has never been reported in liver transplant recipients.MethodsA 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.ResultsSurgery 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.ConclusionsThis 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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