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

Abstract

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.

Pure Laparoscopic Donor Hepatectomy: A Multicenter Experience

“…(19) Regarding PLDLH, only 1 study directly compared 8 PLDLH patients with 18 patients receiving open donor left hepatectomies. (20) Other reports are mostly comparative studies on LLS that have small sample sizes or case series with <10 patients. (15,(21)(22)(23) On the contrary, the empirical findings support the safety and feasibility of PLDH (particularly PLDRH) and PLDLH, with over 500 samples from 5 active LDLT centers.…”

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation – A systematic review and meta-analysis

“…The search strategy identified a number of studies from the same centres with overlapping data, majority of them from Korean centres. The two centres with multiple overlapping publications were Seoul National University Hospital (SNUH)[ 25 26 27 28 29 30 31 32 ] and Samsung Medical Centre (SMC). [ 33 34 35 36 ] Two multicenter studies, one from the West[ 37 ] and one from the East[ 14 ] compiled data from multiple centres.…”

Pediatric living donor liver transplantation: results of laparoscopic vs. open graft removal

“…To this end, and thanks to the advance of surgery, laparoscopy has emerged as an important tool for donor hepatectomy in the last decades. In the hands of an expert surgeon, recovery benefits and improved esthetic results have been clearly demonstrated in various studies (4,(6)(7)(8)(9)(10)(11)(12) . In our sample, no severe complications were recorded in any of the donors using either of the surgical approaches, with no differences in operating times and hospital stay.…”

“…In order to reduce morbidity and facilitate the donor's recovery, Cherqui published the first laparoscopic liver graft removal with subsequent successful implantation in a pediatric patient in 2002 (6) . Multiple studies support the benefits of minimally invasive graft removal for the donor (4,(6)(7)(8)(9)(10)(11)(12)(13)(14) . However, there are fewer articles describing graft progression in pediatric patients.…”