SINGAPORE: Liver donation in Singapore can now be done using keyhole surgery instead of open surgery, leaving donors with smaller scars, less pain, and a shorter recovery time.
The minimally invasive surgery, which is done at the National University Hospital (NUH), involves dividing the liver into two parts, making small incisions on the abdomen ranging from 5 to 10mm, and taking the pieces out via a 5 to 7cm cut above the pubic region - like in a caesarean section.
AdvertisementAdvertisementThis is opposed to a 20 to 25cm large J-shaped incision for a liver transplantation for an adult donor, a spokesperson for the hospital said.
On average, donors who have undergone surgery via the minimally invasive procedure will be hospitalised for three days and can return to normal activities in a week.
In comparison, the average length of stay for donors who have undergone open surgery is five days and they may require two weeks to a month before being able to resume their normal activities, the spokesperson added.
“Using keyhole to do the donor operation does not only offer the patient much less pain post-up, it allows them to recover faster with early mobilisation, significantly shorter hospital stay," said Dr Alfred Kow, senior consultant at the National University Centre for Organ Transplantation (NUCOT).
AdvertisementAdvertisement"More importantly, in the long term, these scars are much smaller.”
[h=3]READ: When it's life or death: Family members donate livers to relatives despite risks[/h]Hopefully, the less invasive surgery will encourage more people to donate their livers, he said, speaking at a media briefing held on Friday (Mar 19) to share about the keyhole surgery.
“We have donors who come forward, but the moment after counselling, (when) we usually will show them how big the scar is, many patients will then have a double mind about stepping forward subsequently,” he said.
AdvertisementNUH has been seeing 30 to 50 cases of liver failure or liver cancer every year, with a majority requiring liver transplantation, Dr Kow said.
According to the latest available national data, as of June last year, the average waiting time for a liver is about 20 months.
The first minimally invasive liver transplantation was done by Dr Kow in 2017, and 15 have been done so far. Of these, eight are paediatric living donor liver transplantations, and seven are adult.
Dr Kow said that it is now the appropriate time to share about the new approach as he and his team were initially "slowly building up the experience and competency" for this type of surgery.
NOT ALL DONORS CAN UNDERGO KEYHOLE SURGERY
There are donors however who may not be suitable for the minimally invasive surgery.
“If the liver that needs to be removed is too big, it is not suitable, because it will cause problems, because the liver will be very heavy during the operation. It is technically difficult to do,” Dr Kow explained.
Donors who are overweight and have limited space in their upper abdomen will also not be suitable.
Dr Kow said that 55 to 60 transplantations are done at NUCOT every year. Almost two-thirds of these are living donor transplantations, he added.
[h=3]READ: 'Extraordinary heroes': Brothers donate their organs to strangers, 7 years apart[/h]He estimated that 10 to 20 per cent of donors will be suitable for the minimally invasive surgery, also called a laparoscopic procedure.
“As we are more competent and mature in this technique, later on, possibly can be up to half,” he said. In major centres, for example in South Korea, they offer this surgery to all donors, he noted.
“The open operation by far is still the standard, but at this point in time, selected patients with appropriate anatomy that is suitable, we would want to extend this benefit to the patient,” he said.
Ms Sophie Chua, a 31-year-old housewife, is one donor who underwent the minimally invasive surgery in August last year in order to donate her liver to her son. Her son, now aged four, was born with a liver condition that required transplantation.
Ms Chua, who was also present at the briefing, said that Dr Kow explained to her both surgical approaches and that she felt more comfortable with the minimally invasive approach as it would leave her with a smaller scar and a faster recovery.
“True enough, I left the operating theatre with only a 5cm cut and was fast recovering back to normal, allowing me to visit and take care of my son who was hospitalised for three weeks after the transplant surgery,” she said.
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