Pure laparoscopic living donor hepatectomy: Focus on 55 donors undergoing right hepatectomy

Abstract

Although laparoscopic donor hepatectomy is increasingly common, few centers with substantial experience have reported the results of pure laparoscopic donor right hepatectomy (PLDRH). Here, we report the experiences of 60 consecutive liver donors undergoing pure laparoscopic donor hepatectomy (PLDH), with most undergoing right hepatectomy. None of the 60 donors who underwent PLDH had intraoperative complications and none required transfusions, reoperation, or conversion to open hepatectomy. Forty-five donors who underwent PLDRH between November 2015 and December 2016 were compared with 42 who underwent conventional donor right hepatectomy (CDRH) between May 2013 and February 2014. The total operation time was longer (330.7 vs 280.0 minutes; P < .001) and the percentage with multiple bile duct openings was higher (53.3% vs 26.2%; P = .010) in the PLDRH group. However, the length of postoperative hospital stay (8.4 vs 8.2 days; P = .495) and rate of complications (11.9% vs 8.9%; P = .733) and re-hospitalizations (4.8% vs 4.4%; P = 1.000) were similar in both groups. PLDH, including PLDRH, is feasible when performed by a highly experienced surgeon and transplant team. Further evaluation, including long-term results, may support these preliminary findings of comparative outcomes for donors undergoing PLDRH and CDRH.

Laparoscopic Donor Hepatectomy for Adult Living Donor Liver Transplantation Recipients

“…Therefore, we think that improvement of surgical techniques to better find the best division plane could possibly ameliorate the outcome and allow expansion of donor selection in the future. Indocyanine green (ICG) fluoroscopy technology, a new technology used more widely in recent years, has been shown to allow real‐time visualization and division of the bile duct . It would make finding the exact plane of division easier, which could improve our current result but more data would be necessary to draw this conclusion.…”

“…Using clips instead of suture would not only be technically easier but could yield a better biliary complication rate. However, the loss of 3‐4 mm length of the bile duct would be inevitable, and this would result in an increased chance of multiple bile ducts on the graft (53.3% in laparoscopic versus 26.2% in open), which could lead to an increased biliary complication rate in the recipient . It must therefore be emphasized that the selection of donors should be done wisely and be considered as important as the surgical technique itself in order to assure a satisfactory outcome in both the donor and recipient.…”

“…However, it is more difficult to approach laparoscopically and is technically more demanding . Even after 2 decades of experience in laparoscopic hepatectomy, the laparoscopic approach for right hepatectomy in living donors is still in the developmental stage (II) under the Balliol classification scheme of the IDEAL model (innovation, development, early dispersion and exploration, assessment, longterm implementation, and monitoring), and the experience remains very limited …”

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

“…All donors were informed of the innovative nature of PLDH and were provided written informed consent after choosing the type of operation. The donor evaluation process at our center has been described previously . A full left lobe graft was considered in donors whose remnant liver volume was expected to be small (<30%) if a right hepatectomy was performed.…”

“…The PLDLH technique is based on the liver hanging maneuver, the demarcation of the exact midplane of the liver using indocyanine green (ICG) near‐infrared fluorescence, and the optimal bile duct division using real‐time ICG near‐infrared fluorescence cholangiography, which is similar to the PLDRH technique (Fig. ) . The PLDRH technique used at our center has been described in detail elsewhere .…”