Minimally invasive donor hepatectomy, are we ready for prime time?

Au, Kin Pan; Chok, Kenneth S. H.

doi:10.3748/wjg.v24.i25.2698

Cited by 29 publications

(20 citation statements)

References 88 publications

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“…The mean difference of 116 mg had a 95% CI of 66-167 mg and was significant (P < 0.001), but NPRS in the PACU score did not differ significantly between the two groups (P = 0.573). Patients in the ODRH group had a significantly longer median postoperative hospital stay (10 [8-12] days; P = 0.003), time to the first meal after surgery (3 [2,3] days; P < 0.001), and time to JP removal after surgery (6 [5][6][7][8] days; P = 0.005), compared to patients in the PLDRH group (9 [8][9][10][11] days, 1 [1,2] day, and 6 [4][5][6][7][8] days, respectively). The respective median difference was 1 day for each comparison, and the respective 95% CIs were 0-2, 1-2, and 0-1 days.…”

Section: Resultsmentioning

confidence: 99%

“…Although hand-assisted, laparoscopic, right lobe donor hepatectomy through a subxyphoid vertical incision was introduced in 2006 19 , PLDRH has only recently been attempted in a few highly specialized centers 20 . Preliminary studies of these attempts revealed that the postoperative short-term outcomes were comparable to those of the open approach 7,[9][10][11] . In particular, Kim et al demonstrated the feasibility of pure laparoscopic procedures in three donors undergoing right hepatectomies 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Over time, the initial clinical acceptance of hand-assisted laparoscopic, donor right hepatectomy advanced to the adoption of pure laparoscopic donor right hepatectomy (PLDRH) 1,8 . Several preliminary studies suggested that PLDRH was safe and reproducible in the hands of experienced surgeons 7,[9][10][11] . However, the available data focus principally on the incidence and nature of surgery-related complications 12 ; neither perioperative complications nor postoperative short-term outcomes of PLDRH have been fully evaluated.…”

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confidence: 99%

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

Jeong

Chung

et al. 2020

Sci Rep

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Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.Laparoscopic liver surgery has become widely accepted, affording many benefits including fewer overall complications, less blood loss, lower pain scores, better donor quality-of-life during the early postoperative period, and a shorter hospital stay, compared to open surgery 1-3 . As surgical techniques advanced over time, laparoscopic surgery for living donor liver transplantation (LDLT) became possible 2 . After the first successful reports of laparoscopic left lateral sectionectomy during adult-to-child LDLT in 2002 4 , many centers adopted the laparoscopic approach as the standard for living liver donors undergoing small graft resections 5,6 . However, the use of laparoscopic procedures to perform larger graft resections (such as right hepatectomies) was initially limited by technical complexities and the steep learning curve associated with the procedures. However, a series of laparoscopic right hepatectomies performed by experienced surgeons at living donor centers showed that the results open Scientific RepoRtS | (2020) 10:5314 | https://doi.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Jeong

Chung

et al. 2020

Sci Rep

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“…Laparoscopic surgery is widely and diversely utilized in various surgical areas providing several advantages compared to open surgery in terms of faster postoperative recovery, shorter hospital stays, and better cosmetic outcomes 12. Laparoscopic hepatectomy has developed relatively slowly compared to other abdominal surgeries due to the long learning curve, technical difficulties, risk of bleeding and questionable long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Pure 3D laparoscopy versus open right hemihepatectomy in a donor with type II and III portal vein variations

Park

Shehta

Lee

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsPure laparoscopic living donor right hemihepatectomy (PLDRH) has been performed in many experienced centers. However, portal vein variations still remain challenging thus disturbing the widespread of PLDRH in many centers. PLDRH when integrated with 3-dimensional laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography is safe and feasible.MethodsWe reviewed 19 donors with separated right anterior and right posterior portal veins who underwent living donor right hemihepatectomy between January 2014 and December 2016. We compared the clinical outcomes of PLDRH and conventional open right hemihepatectomy (CDRH).Results6 donors (31.6%) underwent PLDRH while 13 donors (68.4%) underwent CDRH. There was no intraoperative complications, transfusions and open conversions in the PLDRH donors. The total operative time was longer in PLDRH (356.5 vs. 244.5 minutes, p=0.003). However, the length of hospital stay (8.5 vs. 9.0 days, p=0.703), blood loss (450.0 vs. 393.6 ml, p=0.557) and complication rate (16.6% vs.27.3%; p=0.327) did not differ between the two groups.ConclusionsPLDRH is safe and feasible in donors with type II and III portal vein variations. Further prospective comparative studies are needed to prove the safety and efficacy of PLDRH.

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“…Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the minimally invasive surgery era. (1,2) Pure laparoscopic donor left lateral sectionectomy, which was first performed in 2001, (3) is now considered standard practice like the conventional open approach in highly specialized centers by international consensus. (4) However, pure laparoscopic donor major hepatectomy (PLDMH), including right and left hepatectomy, is not yet recommended widely.…”

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confidence: 99%

Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation

et al. 2020

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Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the era of minimally invasive surgeries. However, the outcomes of pure laparoscopic donor left hepatectomy (PLDLH) are relatively less known than for left lateral sectionectomy or right hepatectomy. This study aimed to report our experience with and the outcomes of PLDLH including the middle hepatic vein (MHV) and to compare these outcomes with conventional donor left hepatectomy (CDLH). The medical records of living liver donors between January 2010 and January 2018 at Seoul National University Hospital were retrospectively reviewed. Donors who underwent left hepatectomy including the MHV were included. To minimize selection bias, donors who underwent CDLH after the initiation of the PLDH program were excluded. Finally, there were 18 donors who underwent CDLH and 8 who underwent PLDLH. The median (interquartile range [IQR]) warm ischemia time (11 [10‐16] minutes versus 4 [2‐7] minutes; P = 0.001) was longer in the PLDLH group than the CDLH group. The total operation time (333 [281‐376] minutes versus 265 [255‐308] minutes; P = 0.09) and time to remove the liver (245 [196‐276] minutes versus 182 [172‐205] minutes; P = 0.08) were also longer in PLDLH although not statistically significant. The length of postoperative hospital stay was significantly shorter in the PLDLH group (7 [7‐8] days versus 9 [8‐10] days; P = 0.01). There were no postoperative complications in the PLDLH group. The rate of complications in recipients was similar in both groups. In conclusion, PLDLH including the MHV appears to be safe and feasible. Further analysis including longterm outcomes is needed.

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Minimally invasive donor hepatectomy, are we ready for prime time?

Cited by 29 publications

References 88 publications

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

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

Pure 3D laparoscopy versus open right hemihepatectomy in a donor with type II and III portal vein variations

Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation

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