Even after 2 decades of experience in laparoscopic hepatectomy, data on purely laparoscopic approach for donor hepatectomy in adult living donor liver transplantation (LDLT) are limited. We report our initial experience of a purely laparoscopic approach for donor hepatectomy for adult recipients to explore its potential application in the management of donors. We did a retrospective data analysis of 54 consecutive patients operated on between May 2013 and February 2015. There were 41 right, 10 extended right, and 3 left hepatectomies. The median operative time was 436 minutes (range 294-684 minutes), and warm ischemia time was 6 minutes (2-12 minutes). Estimated blood loss was 300 mL (10-850 mL), and none of the patients required intraoperative transfusion. Four cases were converted to open laparotomy. The major complication rate was 16.7%, and biliary complication was the most frequent cause. Patients with normal anatomy had a major complication rate of 9.3% as compared with 45.5% in patients with anatomic variations. All patients recovered, and there was no mortality. In conclusion, a purely laparoscopic donor hepatectomy for adult LDLT recipients seems to be a feasible option; with careful patient selection and when performed by experienced surgeons, it may afford results comparable to the open method.

BackgroundThis study analyzed the feasibility of laparoscopic living donor hepatectomy compared to open surgery.MethodsDonors who underwent living donor right from May 2013 to October 2017 were included. Comparisons between laparoscopy and open surgery were performed using Student's t‐test, Mann–Whitney test, χ2 test, Fisher's exact test, and linear‐by‐linear association.ResultsAmong 305 donors, 100 and 205 underwent laparoscopy and open surgery, respectively. The laparoscopy group had more type I (95.0%) bile ducts than the open group (59.5%, P < 0.001) and had longer operation time (378.2 ± 93.5 min vs. 329.1 ± 68.0 min, P < 0.001), while estimated blood loss was smaller (298.3 ± 162.9 ml vs. 344.3 ± 149.9 ml, P = 0.015). Although Clavien‐Dindo grade IIIb complication was higher in the laparoscopy (n = 4, 4.0%) compared to the open group (0.0%, P = 0.011), it was only significant in the initial 25 cases (8.0%, P = 0.011), and became comparable afterwards. Furthermore, grade IIIb complication was comparable when type I bile duct donors were selected (P = 0.072).ConclusionsLaparoscopic living donor hepatectomy can cause significant complication in the initial stage. Therefore, careful donor selection and well‐established training program are required for introducing the laparoscopic donor program.

Background The feasibility and learning curve of laparoscopic living donor right hepatectomy was assessed. Methods Donors who underwent right hepatectomy performed by a single surgeon were reviewed. Comparisons between open and laparoscopy regarding operative outcomes, including number of bile duct openings in the graft, were performed using propensity score matching. Results From 2014 to 2018, 103 and 96 donors underwent laparoscopic and open living donor right hepatectomy respectively, of whom 64 donors from each group were matched. Mean(s.d.) duration of operation (252·2(41·9) versus 304·4(66·5) min; P &lt; 0·001) and median duration of hospital stay (8 versus 10 days; P = 0·002) were shorter in the laparoscopy group. There was no difference in complication rates of donors (P = 0·298) or recipients (P = 0·394) between the two groups. Total time for laparoscopy decreased linearly (R2 = 0·407, β = –0·914, P = 0·001), with the decrease starting after approximately 50 procedures when cases were divided into four quartiles (2nd versus 3rd quartile, P = 0·001; 3rd versus 4th quartile, P = 0·023). Although grafts with bile duct openings were more abundant in the laparoscopy group (P = 0·022), no difference was found in the last two quartiles (P = 0·207). Conclusion Laparoscopic living donor right hepatectomy is feasible and an experience of approximately 50 cases may surpass the learning curve.