NEW DELHI: Doctors at Fortis Hospital in Gurugram recently conducted a liver donation through laparoscopic surgery. Hepatectomy—removal of a part of liver from a donor—is usually done through open surgery as the liver is a large and vascular organ with a high risk of bleeding.
The case involved a two-and-a-half-year-old child suffering from end-stage liver disease. His mother, a 28-year-old Iraqi woman, volunteered to donate a part of her liver to her ailing son for a transplant. Dr Vivek Vij, director of liver transplant at Fortis hospitals, said in India there are no reported cases of hepatectomy through laparoscopic surgery. “But in US and other countries, there have been multiple such surgeries. It has a good success rate especially when the donor is young. Hence, we decided to attempt it in this case,” Dr Vij added.
He said they had attempted laparoscopic resection in at least four to five patients earlier, in part, before attempting total resection in this case. It took about 10 hours to harvest the donor’s liver and transplant it.
The Fortis doctor said they made five small holes of approximately 1cm each on the donor’s abdomen and used it to insert scopes with cameras fitted on them and instruments to visualise and clear the hepatic vein and artery among others.
The liver, weighing one-and-a-half kilograms, is the body’s largest organ and its main chemical factory. There are thousands of blood vessels crossing through its lobes, and separating them to avoid bleeding risk is difficult. “It requires very high precision to do so without opening the abdomen. Also, unlike a kidney, which weighs around 200 grams, a liver weighs around 1-2kg. It is difficult to handle it with small instruments used for key-hole surgery. So we had to be really patient and careful while operating for the resection,” said Dr Vij.
He said that once the blood vessels had been cleared, they used ultrasonic cutting device to cut apart nearly 20% of the mother’s liver to be transplanted into the child with sharp precision. “It was packed into a tiny bag and taken out for transplantation,” he added.
In India, this is possibly the first case in which such minimally invasive technical procedure has been conducted for liver transplant, the hospital said.
While using minimally invasive surgical techniques to conduct the surgery posed several difficulties, it also presented the patient with several advantages such as less pain and less visible scars. The recovery was smooth and uneventful with minimum hospital stay for the donor, the director of liver transplant at Fortis said.
Vij added that advances in liver surgery would encourage more people to come forward to donate, which is risk-free. Liver transplantation is a treatment option for end-stage liver diseases and acute liver failure, although the availability of donor organs is a major limitation.