Laparoscopy-assisted hepatectomy versus conventional (open) hepatectomy for living donors: When you know better, you do better

Abstract

The conventional incision for donor hepatectomy is a right subcostal incision with a midline extension. With increased experience in both donor hepatectomy and laparoscopy, the conventional incision can be shortened to a significant extent. Laparoscopic mobilization of the liver coupled with a hand port allows the insertion of one hand inside the abdomen for control; this makes small-incision donor hepatectomy a technically feasible alternative. We compared 26 right lobe donor hepatectomies performed with a laparoscopy-assisted technique (the laparoscopy-assisted donor hepatectomy group) to 24 donor hepatectomies performed with the conventional open technique (the conventional donor hepatectomy group). The donors in both groups and their recipients were followed for 6 months. Pain, discomfort related to the scar [including abdominal wall sensorineural deficits (numbness and differences in tactile and temperature sensations) and tightness around the scar], and donor quality of life (assessed with the International Quality of Life Assessment Short Form 8 scoring system) were compared between the 2 groups. In conclusion, laparoscopy-assisted surgery can be a technically feasible alternative in experienced hands, and as with other minimally invasive surgeries, it has advantages such as significantly less pain, reduced incision-related complications, and better donor quality of life during the early postoperative period without compromising donor safety.

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

“…The level of evidence of these articles was estimated using the United Kingdom Cochrane Centre of Evidence (2001)[28]. Six articles described cohort studies comparing contemporary series of patients (level of evidence: 2b)[12,16,19-22]; five articles were retrospective case-control studies (level of evidence: 3b)[13-15,18,24], and two articles were retrospective studies using historical series as controls (level of evidence: 4)[17,23]. …”

Meta-Analysis of Laparoscopic versus Open Hepatectomy for Live Liver Donors

“…Our results demonstrated that LLDH was associated with significantly longer operative time, which could be explained by the frequent installation and removal of laparoscopic devices, mobilization and dissection the lobe of the liver under laparoscopy as well as surgeons’ experience and initial learning curve[26, 27]. Meanwhile, the operative time difference between LLDH and OLDH might correlate with the type of hepatectomy.…”

“…Four studies were conducted in Korea[22, 23, 25, 27], one in the United States[21], one in France[12], one in China[24]. , one in Japan[13], and one in India[26]. The sample size of the included studies ranged from 22 to 493 patients.…”

“…The sample size of the included studies ranged from 22 to 493 patients. Seven of the nine studies reported on the conversion rate in LLDH group, which varied from 0 to 10%[12, 13, 21–24, 26]. The reasons for conversion including a left portal branch injury (n = 1), a right hepatic vein injury (n = 1) and an inferior vena cava injury (n = 1).…”

“…The six case-control studies involved in our meta-analysis were all hospital based[12, 21–23, 26, 27]. Meanwhile, several studies with small sample size brought some concerns regarding the reliability of their results[12, 13, 21–26]. To address this issue, we applied the random-effects model to determine the overall estimate of variability.…”