{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:16:23Z","timestamp":1788419783601,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the safety and feasibility of a \u201cParenchyma-First\u201d approach for laparoscopic left lateral sectionectomy (LLS) in living donor hepatectomy, with the primary goal of minimizing vascular injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To avoid premature and excessive dissection of the portal vein and hepatic artery at the first hepatic hilum\u2014which increases the risk of vascular injury\u2014and to prevent torsion or occlusion of these mobilized vessels during parenchymal transection, we adopted a technique that prioritizes liver parenchymal transection before dissecting the left hepatic artery and left portal vein branch. A single-center, retrospective, descriptive study of 46 donors and pediatric recipients (April 2023\u2013June 2025). No control group was included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean donor operative time was 289.7\u2009\u00b1\u200966.7 min, blood loss 71.5\u2009\u00b1\u200960.3 mL, and warm ischemia time 297.8\u2009\u00b1\u200998.6\u2005s. No donor vascular or biliary complications occurred; one donor underwent reoperation for omental bleeding. Among recipients, mortality was 4.3% (2\/46) due to recipient-related vascular complications. Vascular or biliary interventions were required in 10.9% (5\/46) of recipients. Early allograft dysfunction occurred in 17.4% of recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The \u201cParenchyma-First\u201d approach for left lateral section graft procurement is technically feasible, provides excellent donor safety by protecting hilar vasculature, and yields acceptable recipient outcomes comparable with international series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1829650","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:43:02Z","timestamp":1788417782000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of \u201cparenchyma-first\u201d approach in laparoscopic living donor left lateral sectionectomy"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaining","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binsheng","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhong","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-Sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"919","DOI":"10.21037\/hbsn-24-329","article-title":"Chinese Guidelines for minimally invasive donor hepatectomy in living donor liver transplantation (2024 edition)","volume":"13","author":"Xu","year":"2024","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/SLA.0000000000004475","article-title":"Expert consensus guidelines on minimally invasive donor hepatectomy for living donor liver transplantation from innovation to implementation: a joint initiative from the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA)","volume":"273","author":"Cherqui","year":"2021","journal-title":"Ann 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status","volume":"22","author":"Park","year":"2015","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1111\/ajt.17042","article-title":"Pure laparoscopic donor hepatectomy: experience of 556 cases at Seoul National University Hospital","volume":"24","author":"Hong","year":"2024","journal-title":"Am J Transplant"},{"key":"B7","first-page":"481","article-title":"A brief discussion of Glisson pedic-first approach in laparoscopic anatomical hepatectomy","volume":"29","author":"Zeng","year":"2023","journal-title":"Chin J Hepatobiliary Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/s00464-014-3649-9","article-title":"Total laparoscopic living donor right hepatectomy","volume":"29","author":"Han","year":"2015","journal-title":"Surg Endosc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"4677","DOI":"10.1007\/s00464-020-07649-7","article-title":"Anterior approach for pure 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Nutr"},{"key":"B13","first-page":"323","article-title":"Clinical application of fluorescence laparoscopy in living donor left lateral sectionectomy for pediatric liver transplantation","volume":"45","author":"Lou","year":"2024","journal-title":"Chin J Organ Transplant"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1829650\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:43:04Z","timestamp":1788417784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1829650\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":13,"alternative-id":["10.3389\/fsurg.2026.1829650"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1829650","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1829650"}}