Influence of Large Grafts Weighing ≥ 1000 g on Outcome of Pure Laparoscopic Donor Right Hepatectomy

Lapisatepun, Worakitti; Hong, Suk Kyun; Hong, Kyoung Sup; Han, Eui Soo; Lee, Jeong Moo; Yi, Nam Joon; Lee, Kwang Woong; Suh, Kyung Suk

doi:10.1007/s11605-020-04837-7

Cited by 12 publications

(28 citation statements)

References 34 publications

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“…This indicates that liver volume is not a determinant of the feasibility of PLDRH. Similar results have been reported in our previous study regarding graft volume [ 10 ]. The larger liver volumes in the CDRHM group can be explained by the relatively higher female ratio (30 of 40 in PLDRHM vs. 4 of 10 in CDRHM) in the PLDRHM group.…”

Section: Discussionsupporting

confidence: 92%

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Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein: a comparison of outcomes and safety

et al. 2022

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Purpose Analyses on pure laparoscopy in donor hepatectomies, including the middle hepatic vein (MHV), are still scarce. This study aimed to compare the outcomes of donor right hepatectomy, including the MHV, when performed laparoscopically with conventional open surgery. Methods Data from living donors who underwent donor right hepatectomy between January 2012 and December 2020 were retrospectively analyzed. The intraoperative and postoperative complication rates of the pure laparoscopic donor right hepatectomy (PLDRH) with MHV inclusion (PLDRHM) group were compared with the conventional open donor right hepatectomy with MHV inclusion (CDRHM) group and the PLDRH without MHV inclusion [PLDRHM(–)] group. Results Compared to the CDRHM group, the PLDRHM group had a longer bench time (P < 0.001) and higher Δ%, calculated as [(preoperative value – postoperative value)/preoperative value] × 100, of AST (P < 0.001), ALT (P < 0.001), and total bilirubin (P = 0.023), but shorter hospital stay (P = 0.004) and a lower rate of complications (P = 0.005). Compared to the PLDRHM(–) group, the PLDRHM group had fewer male donors (P < 0.001) and a lower body mass index (P < 0.001), estimated total liver volume (P < 0.001), and real graft weight (P < 0.001). Results of laboratory changes, hospital stays, and complication rates were similar between the 2 groups. Conclusion PLDRH with the inclusion of the MHV in selected donors and recipients is feasible and safe when performed by surgeons experienced in laparoscopic surgery, with favorable complication rates compared to CDRHM and PLDRHM(–).

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Section: Discussionsupporting

confidence: 92%

“…Advances in technology such as the development of the 3-dimensional (3D) laparoscope, flexible scope, and indocyanine green near-infrared fluorescence ushered in a new era of pure laparoscopic donor hepatectomy (PLDH). Since 2014, several studies and analyses have proved the safety and feasibility of PLDH [ 9 10 11 ].…”

Section: Introductionmentioning

confidence: 99%

Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein: a comparison of outcomes and safety

et al. 2022

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“…Previously, there were donor selection criteria proposed by Kim et al [ 8 ] in which graft weight should be smaller than 500 g due to the difficulty of graft manipulation and the largest parenchymal transection areas. However, our result corresponded to a study from Lapisatepun et al [ 9 ], which showed that graft weight affects neither donor outcomes nor graft function after PLDRH. The elevation of aspartate aminotransferase (AST) postoperatively may be caused by hepatocyte injury from liver mobilization and parenchymal transection [ 10 , 11 ].…”

Section: Discussionsupporting

confidence: 90%

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

et al. 2022

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Background Pure laparoscopic donor right hepatectomy (PLDRH) can provide better operative outcomes for the donor than conventional open donor right hepatectomy (CODRH). However, the complexity of the procedure typically makes transplant teams reluctant to perform it, especially in low-volume transplant centers. We compared the outcomes of PLDRH and CODRH to demonstrate the feasibility of PLDRH in a low-volume transplant program. Methods We carried out a retrospective study of adult living donor liver transplantation in Chiang Mai University Hospital from January 2015 to March 2021. The patients were divided into a PLDRH group and a CODRH group. Baseline characteristics, operative parameters, and postoperative complications of donors and recipients were compared between the two groups. Results Thirty patients underwent donor hepatectomy between the dates selected (9 PLDRH patients and 21 CODRH patients). The baseline characteristics of the 2 groups were not significantly different. The median graft volume of the PLDRH group was 693.8 mL, which was not significantly different from that of the CODRH group (726.5 mL) The PLDRH group had a longer operative time than the CODRH group, but the difference was not statistically significant (487.5 min vs 425.0 min, p = 0.197). The overall complication rate was not significantly different between the two groups (33.3% vs 22.2%, p = 0.555). Additionally, for the recipients, the incidence of major complications was not significantly different between the groups (71.3 vs 55.6%, p = 0.792). Conclusion Even in the context of this low-volume transplant program, whose staff have a high level of experience in minimally invasive hepatobiliary surgery, PLDRH showed similar results to CODRH in terms of perioperative outcomes for donors and recipients.

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“…In this study, warm ischemia time, operative duration, and blood loss were comparable between the two arms. A previous study comparing large grafts ≥ 1000 g (n = 10) with standard grafts for laparoscopic donor hepatectomy (n = 280) and open donors with graft weight ≥ 1000 g (n = 24) reported significantly higher operative duration and warm ischemia time 23 . We did not persist with complete mobilization of large grafts if difficulty with attachments at the cranial end of IVC and diaphragm was encountered.…”

Section: Discussionmentioning

confidence: 70%

Extended criteria donors for robotic right hepatectomy: A propensity score matched analysis

Varghese

Chandran

Gopalakrishnan

et al. 2022

J Hepato Biliary Pancreat

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Background: Robotic right donor hepatectomy (RDH) has been reported from experienced centers with reduced morbidity when compared to open RDH. However, outcomes in donors with large grafts/complex biliovascular anatomy are unknown.Methods: Out of 170 robotic RDH, 100 had one or more of the following: graft weight ≥800 g, type 2/3 portal vein, >1 bile duct or hepatic artery and inferior hepatic veins >5 mm requiring reconstruction (extended criteria donors [ExRDH]), while the remaining 70 had standard anatomy (SRDH). After propensity score matching, 66 ExRDH were compared with 66 SRDH. Additionally, all robotic RDH performed were analyzed in three temporal phases (60, 60, and 50).Results: Peak AST and ALT were higher amongst donors and recipients in the ExRDH arm compared to SRDH. Other intraoperative parameters and postoperative complications were similar between the two groups. During the last phase, donors demonstrated reduction in duration of surgery, postoperative complications, and hospital stay while recipients showed decreased blood loss and hospital stay. Conclusion:Robotic right hepatectomy performed in donors with extended criteria have similar perioperative outcomes as standard donors. However, a significant learning curve needs to be traversed. Further studies are required before safely recommending robotic RDH for all donors.

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Influence of Large Grafts Weighing ≥ 1000 g on Outcome of Pure Laparoscopic Donor Right Hepatectomy

Cited by 12 publications

References 34 publications

Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein: a comparison of outcomes and safety

Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein: a comparison of outcomes and safety

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

Extended criteria donors for robotic right hepatectomy: A propensity score matched analysis

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