Comparison of the efficacy and safety of magnetic-assisted anastomosis in open and laparoscopic liver transplantation vascular anastomosis

Objective To investigate the feasibility and safety of magnetic-assisted vascular anastomosis in open and laparoscopic liver transplantation. Methods Clinical data of 19 patients who underwent orthotopic liver transplantation at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from November 2018 to December 2024 were retrospectively analyzed, including 14 males and 5 females, aged (47.4±11.4) years. Among them, 15 cases had primary liver cirrhosis and four had primary liver cancer. Patients were divided into laparoscopic group (n=10) and open group (n=9) based on the surgical approach. Magnetic anastomosis was applied to reconstruct the portal vein, suprahepatic inferior vena cava (IVC), and infrahepatic IVC in both groups. The donors included 13 males and 6 females, aged 40.0 (33.0, 45.0) years. Recipient operation time, anhepatic phase, intraoperative blood loss, serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin on postoperative day (POD) 5, and postoperative complications (including portal vein thrombosis, hepatic vein thrombosis, biliary stricture, acute rejection, acute renal insufficiency, etc.) were compared between the groups. Results The anhepatic phase in the laparoscopic group was significantly longer than that in the open group [21.0 (19.0, 23.0) vs 15.0 (14.0, 16.0), min, Z=2.67, P=0.022]. The operation time in the laparoscopic group was also longer than that in the open group (t=5.98, P<0.001). Intraoperative blood loss, serum levels of ALT, AST, and total bilirubin on POD 5 were comparable between the groups (all P>0.05). Postoperative complications in the laparoscopic group included one case of biliary stricture, one case of acute rejection, and one case of acute renal insufficiency. One case of hepatic artery thrombosis, one case of portal vein thrombosis, one case of biliary stricture, and one case of acute rejection occurred in the open group. No significant difference was found in the overall incidence of postoperative complications between the groups [30.0%(3/10) vs 44.4%(4/9), P=0.999]. Conclusion Magnetic-assised anastomosis technique could be feasible in both open and laparoscopic liver transplantation. Postoperative liver function recovery and complications were comparable between laparoscopic and open surgery. Magnetic-assisted anastomosis technique provided important technical support for vascular anastomosis in laparoscopic liver transplantation.