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Minimally invasive surgery and liver transplantation: is it a safe, feasible, and effective approach?

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Abstract

The minimally invasive approach (MIS) is undoubtedly one of the most important breakthroughs in surgery in recent decades. Consequently, MIS has been increasingly in the field of liver transplantation (LT). The objective of the present review was to determine the current status of MIS with respect to liver transplantation (LT) and what would be the indications for an MIS in this context today. The literature was searched for publications reporting the MIS in LT. Only those articles that described the results according to whether the MIS had been performed to treat transplant complications (urgent or late), another pathology not related to the LT, or to perform the liver explantation and graft implantation were included. From 2000 to 2022, 33 studies and 261 patients were included. Most frequent indications were incisional hernias secondary to LT followed by the treatment of other pathologies not related with the LT and treatment of LT complications. Only a 12% were urgent interventions. Few studies describe conversions with an average rate of 2.5%. Morbidity do not differ significantly from open surgery. No case of mortality or graft loss was described. Purely laparoscopic liver explants in 9 patients with 2 conversions and 3 cases of graft implantation with a higher warm ischemia in the MIS implants grafts were described. The limitations of MIS in LT are relative and probably depend more on training, experience, and skills of the surgeons. This approach could be safety and feasibility to solved complications or in other individualized indications in LT patients. The initial experiences in liver explant and graft implantation need further investigations.

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Data availability

The authors and collaborators confrm that the data supporting the fndings of this study are available within the article and its supplementary material. Raw data that support the fndings of this study are available from the corresponding author, upon request.

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Acknowledgements

We would like to thank professors Ricardo Robles-Campos and Francisco Sánchez-Bueno, and the entire nursing team of the liver transplant unit for their collaboration.

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Author notes

  1. Víctor López-López and María Ángeles Martínez-Serrano have shared first authorship.

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain

    Víctor López-López, Juan José Ruiz-Manzanera & Pablo Ramirez

  2. Department of General and Digestive Surgery, Torrevieja University Hospital, Alicante, Spain

    María Ángeles Martínez-Serrano

  3. Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland

    Dilmurodjon Eshmuminov

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  1. Víctor López-López
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Correspondence to Víctor López-López.

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T Víctor López-López, María Ángeles Martínez-Serrano, Juan José Ruiz-Manzanera, Dilmurodjon Eshmuminov, and Pablo Ramirez have no conflicts of interest or financial ties to disclose.

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López-López, V., Martínez-Serrano, M.Á., Ruiz-Manzanera, J.J. et al. Minimally invasive surgery and liver transplantation: is it a safe, feasible, and effective approach?. Updates Surg 75, 807–816 (2023). https://doi.org/10.1007/s13304-023-01506-7

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