IPEG 2024 Round Table Discussion from East Asia - Dr. Atsuhisa Fukuta

OK. Thank you. So the, can we move to the next presentation? Thank you, Doctor Sam Min Lee. So, next presentation to Doctor Atsuhisa Fukuta talking about a liver transplantation. OK. Can you see my slide? OK. Uh, I talk about intraabdominal graft deduction technique in laparoscopic di dal hepatectomy. In pediatric dial liver transplantation, large force size syndrome may result in. Critical complications, including vascular problems and difficulty in closing the abdominal wall. Optimal graph deduction, which is performed with the aim of achieving an acceptable graft size, is an essential procedure. We introduced laparoscopic ratunal hepatectomy in January 2023 and performed 8 cases to date. We introduced our technique for intraabdominal graft reduction in laparoscopic ring donor hepartectomy. Hi I show our technique video, deduce left lateral segmentectomy. After identifying the left. Hepatic artery, left hepatic vein, and portal vein, exposing the gleesome particle of segment 3. After clamp G3, we can see the demarcation line on the reverse surface. Inject ICZ with GC clamped. And confirm. Demarcation line. Monkey In the reverse surface and reduce segment 3. In liver transjection, we use laparoscopic ultrasonic aspirator. And put a sonic vessel sealing system. We usually use for cutting reson branch. Always we use hemmerlock and With the sonic ves sealing systems. This is the graphed part, and this is the reduced part. We performed intraabdominal graft deduction in 3 cases. There were no cases in inoperative surgical complications such as perfusion defect, bleeding, or bow leakage. I think about this procedure, good point is we can identify demarcation line more clearly using ICG. Bleeding and bile leakage from liver graft can be confirmed more clearly using laparoscopic view. But the point is, performing graft reduction insights, the operation time may be extended. OK, thank you. Yeah Great presentations. Can we get the pole? Actually, I don't have any experience for the liver transplantation though. If you guys have the experience. Could you make This pole Leaving do not hepatectomy open or lap or no experience. Majority is no expense, but. And the open would be the 40%. Is there any comments or questions from the moderators? Can I ask one question? Yes, uh, um, you mentioned that the operation time may be extended, but, uh, uh, how long does it take? I mean, operative time. Can you take that? So, uh, thanks. Total operation time is about, uh, always 6 hours, but for reduction time is, um, 1 hour or 1. 1 hour and 30 minutes. Thank you. So, Doctor Fukuda, do you guys have specific training to do the, you know, those transplantation stuff? Uh, so this operation, so in Japan, uh, we need a special license for laparoscopic living donor hepartectomy. So I am a pediatric surgeon. So, um, in this operation, I do scopist and operator is, um, the, um, pancreas adult surgeon. OK. OK. So I, I can't, um, perform this operation. So because I Don't have a special license for living donor hepatectomy. Yeah. Doctor Fukuda, uh, I have a question for the, uh, the, in Japan now, uh, the, uh, lateral segmentectomy by laparoscopy is, uh, uh, uh, covered by insurance now, but the possibility of the, uh, left lobe or right lobe hepartectomy for the, uh, graft harvesting for in the future. Uh, so, Left, mm, maybe, uh, we can, uh, left, uh, segmented to be um In future, uh, we can perform, but, uh, Right, and living on a hypertectomy is very difficult. I think. Maybe I think the technically feasible for the uh lapa laparoscopic hepartectomy for the hepatocellular carcinoma, but different from the uh viability, the reservation for the uh gravity for the uh transplantation is different category, different uh technique. I think so. Thanks. Thank you for the discussions.