Laparoscopic donor hepatectomy in settings of pediatric living donor liver transplantation: single center experience

Abstract

Background:The mini-invasive (MIS) approach to living donor hepatectomy is a current trend in experienced centers. At the same time, there are only a few reports describing the utility of laparoscopic donor hepatectomy (LDH) in settings of pediatric living donor liver transplantation (LDLT). We aimed to provide our own experience as a path to implementing the approach to routine practice. Methods: LDH was used in 276 cases of pediatric LDLT between May 2016 and August 2022. Laparoscopic left lateral sectionectomy (LapLLS) was performed in 240 cases, including 3 cases of simultaneous LapLLS and nephrectomy in the same donor. Laparoscopic living donor left hepatectomy (LapLDLH) was applied in 25 cases, including 2 cases of simultaneous LapLDLH and nephrectomy in the same donor. Laparoscopic right hepatectomy in a living donor (LapLDRH) was performed in 11 cases for LDLT in adolescent recipients. Results: In the LapLLS group, the blood loss was 50 mL (20-400 mL), the median operation time was 203 minutes (120-475 minutes) and the median length of the hospital stay was 5 days (2-19 days). The LapLDLH and LapLDRH groups were characterized by higher median blood loss 320 mL (100-700 mL) and 240 mL (100-400 mL) respectively; and also a longer operative time of 322 minutes (210-415 minutes), 380 minutes (280-470 minutes). The complication rate was similar to open procedure in both donors and recipients. Conclusions: The left-sided graft procurement (LLS and LL) is a more demanded procedure in settings of pediatric LDLT. The laparoscopic approach for living donors demonstrates all the advantages of MIS, with preserving recipient outcomes.