Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular...Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular anastomosis.In this study,we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs.Methods:Two sets of magnetic vascular anastomosis rings(MVARs)with different diameters were developed.One set was used for anastomosis of the suprahepatic vena cava(SHVC)and the other set was used for anastomosis of the infrahepatic vena cava(IHVC)and portal vein(PV).Six laparoscopic orthotopic liver transplantations were performed in pigs.Donor liver was obtained via open surgery.Hepatectomy was performed in the recipients through laparoscopic surgery.Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis,and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance.Results:Liver transplants were successfully performed in five of the six cases.Postoperative ultrasonographic examination showed that the portal inflow was smooth.However,PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other.The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13±5 vs.5±1 min(P<0.01)and 10±2 vs.4±1 min(P<0.05),respectively.The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5±1 vs.1±1 min(P<0.01),and 5±1 vs.1±1 min(P<0.01),respectively.The anhepatic phase was 43±4 min in the laparoscope group and 23±2 min in the manual assistance group(P<0.01).Conclusions:Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.展开更多
A good vascular condition is fundamental for kidney transplantation. A bad arterial or venous supply may compromise graft survival. Discovery in operating theater of vascular anomalies not diagnosed by medical imaging...A good vascular condition is fundamental for kidney transplantation. A bad arterial or venous supply may compromise graft survival. Discovery in operating theater of vascular anomalies not diagnosed by medical imaging may overwhelm operating protocol. Our cases emphasize the issue of pre operating evaluation. The cases are those of two women, aged 48 and 25 years, with chronic renal insufficiency, for whom living donor kidney transplantation was decided. During the process, a total obstruction of iliac vein was found and led to a change of technique. The dilated ovarian vein was used for the venous anastomosis while the arterial anastomosis was as usually made using the iliac artery. Post-surgical follow up was uneventful. These cases emphasize on the mandatory pre operative evaluation and the respect of guidelines in the process of kidney transplantation. They also open access to other operating strategies. The objective of this publication was to present our experience in dealing with an obstructed iliac vein and emphasize on the necessity to assess accurately vascular state in kidney transplantation.展开更多
基金supported by a grant from the Key R&D Project of Shaanxi Province(No.2020GXLH-Z-001)。
文摘Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular anastomosis.In this study,we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs.Methods:Two sets of magnetic vascular anastomosis rings(MVARs)with different diameters were developed.One set was used for anastomosis of the suprahepatic vena cava(SHVC)and the other set was used for anastomosis of the infrahepatic vena cava(IHVC)and portal vein(PV).Six laparoscopic orthotopic liver transplantations were performed in pigs.Donor liver was obtained via open surgery.Hepatectomy was performed in the recipients through laparoscopic surgery.Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis,and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance.Results:Liver transplants were successfully performed in five of the six cases.Postoperative ultrasonographic examination showed that the portal inflow was smooth.However,PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other.The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13±5 vs.5±1 min(P<0.01)and 10±2 vs.4±1 min(P<0.05),respectively.The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5±1 vs.1±1 min(P<0.01),and 5±1 vs.1±1 min(P<0.01),respectively.The anhepatic phase was 43±4 min in the laparoscope group and 23±2 min in the manual assistance group(P<0.01).Conclusions:Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.
文摘A good vascular condition is fundamental for kidney transplantation. A bad arterial or venous supply may compromise graft survival. Discovery in operating theater of vascular anomalies not diagnosed by medical imaging may overwhelm operating protocol. Our cases emphasize the issue of pre operating evaluation. The cases are those of two women, aged 48 and 25 years, with chronic renal insufficiency, for whom living donor kidney transplantation was decided. During the process, a total obstruction of iliac vein was found and led to a change of technique. The dilated ovarian vein was used for the venous anastomosis while the arterial anastomosis was as usually made using the iliac artery. Post-surgical follow up was uneventful. These cases emphasize on the mandatory pre operative evaluation and the respect of guidelines in the process of kidney transplantation. They also open access to other operating strategies. The objective of this publication was to present our experience in dealing with an obstructed iliac vein and emphasize on the necessity to assess accurately vascular state in kidney transplantation.
