Laparoscopic Donor Hepatectomy for Adult Living Donor Liver Transplantation Recipients

Abstract

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.

One‐Year Recipient Morbidity of Liver Transplantation Using Pure Laparoscopic Versus Open Living Donor Right Hepatectomy: Propensity Score Analysis

“…We then returned to the restriction of any anatomical variations, and the expansion of the anatomical criteria required more experience. (19) In this study, the donor complication rate and duration of hospital stay in the propensity-matched population showed no significant differences between the 2 groups. However, this study could not evaluate the effect of donor anatomy on the recipient outcomes because we did not perform separate analyses according to the donor selection criteria.…”

“…Our initial expansion of anatomical criteria after the first 7 successful cases resulted in an increased complication rate. We then returned to the restriction of any anatomical variations, and the expansion of the anatomical criteria required more experience . In this study, the donor complication rate and duration of hospital stay in the propensity‐matched population showed no significant differences between the 2 groups.…”

Comparison of perioperative outcomes between pure laparoscopic surgery and open right hepatectomy in living donor hepatectomy: Propensity score matching analysis

“…Pure laparoscopic procedures has several advantages compared to conventional open surgery, including less wound morbidity and faster recovery 21 . More recently, Kwon et al reported that, after careful donor selection, and using standardized surgical methods, pure laparoscopic donor hepatectomy for adult LDLT was safe and benefitted the donors 22 . Similarly, we found here (in the largest such study to date) that PLDRH donors had lower opioid requirements until postoperative day 7 than the ODRH donors.…”

A Single Center Experience for a Feasibility of Totally Laparoscopic Living Donor Right Hepatectomy

“…Since then, several major liver transplant centers in Korea have started to present short-term results of LDRH based on sufficient experience. 13,14 Careful preparation and blood-saving surgery will signifi-A B C Fig. 4.…”